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TREASURY DEPARTMENT 
Public Health and Marine-Hospital Service of the United States 

HYGIENIC LABORATORY.— BULLETIN No. 56 

March, 1909 



MILK AND ITS RELATION TO THE 
PUBLIC HEALTH 

[Revised and enlarged edition of Bulletin No. 41] 
(BY VARIOUS AUTHORS) 



(SECOND EDITION) 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1912 



Honograph. 



/ 



TREASURY DEPARTMENT 
D ublic Health and Marine-Hospital Service of the United States 



U.S. HYGIENIC LABORATORY.— BULLETIN No, 56 

March, 1909 



MILK AND ITS RELATION TO THE 
PUBLIC HEALTH H^ 



[Revised and enlarged edition of Bulletin No. 41] 



(BY VARIOUS AUTHORS) 



(SECOND EDITION) 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1912 






ORGANIZATION OF HYGIENIC LABORATORY. 

Rupert Blue, Surgeon General, 
United States Public Health and Marine- Hospital Service. 

ADVISORY BOARD. 

Lieut. Col. Walter D. McCaw, surgeon, United States Army; Surg. Charles S. 
Butler, United States Navy; Dr. A. D. Melvin, Chief of United States Bureau of 
Animal Industry; and John F. Anderson, United States Public Health and Marine- 
Hospital Service, ex officio. 

Prof. William H. Welch, Johns Hopkins University, Baltimore, Md.; Prof. Simon 
Flexner, Rockefeller Institute for Medical Research, New York; Prof. Victor C. 
Vaughan, University of Michigan, Ann Arbor, Mich.; Prof. William T. Sedgwick, 
Massachusetts Institute of Technology, Boston, Mass.; and Prof. Frank F. Wesbrook, 
University of Minnesota, Minneapolis, Minn. 

LABORATORY CORPS. 

Director. — Passed Asst. Surg. John F. Anderson. 
Assistant director. — Passed Asst. Surg. Edward Francis. 
Senior pharmacist. — L. W. Ryder. 
Junior pharmacist. — C. 0. Sterns, Ph. G. 
Artist. — Leonard H. Wilder. 
Acting librarian. — E. B. K. Foltz. 

DIVISION OF PATHOLOGY AND BACTERIOLOGY. 

In charge of division. — Passed Asst. Surg. John F. Anderson. 

Assistants. — Passed Asst. Surgs. Edward Francis, L. L. Lumsden, T. B. McClintic, 
J. W. Schereschewsky, Allan J. McLaughlin, B. S. Warren, A. M. Stimson, W. H. 
Frost; Asst. Surgs. Joseph R. Ridlon, S. C. Hotchkiss; and Walter D. Cannon, A. M., 
M. D. 

DIVISION OF ZOOLOGY. 

Professor of zoology. — Ch. Wardell Stiles, Ph. D. 
Assistant. — Passed Asst. Surg. Joseph Goldberger. 

DIVISION OF PHARMACOLOGY. 

Professor of pharmacology . — Reid Hunt, Ph. D., M. D. 

Assistants.— A therton Seidell, Ph. D.; W. H. Schultz, Ph. D.; Worth Hale, A. B., 
M. D.; Murray Gait Motter, A. M., M. D.; Martin I. Wilbert, Ph. M.; G. A. Menge, 
Ph.D. 

DIVISION OF CHEMISTRY. 

Professor of chemistry. — Edward C. Franklin, Ph. D. 

Assistants. — Passed Asst. Surg. Norman Roberts; Elias Elvove, M. S., Phar. D. 



IM, • 



TABLE OF CONTENTS. 



Page. 

1. Introduction (by Walter Wyman) 13 

2. Milk as a Cause of Epidemics of Typhoid Fever, Scarlet Fever, and 

Diphtheria (by John W. Trask) 23 

Typhoid fever , 26 

Bacillus typhosus in milk 27 

Summary of epidemics 29 

Stamford epidemic 30 

Scarlet fever 32 

Summary of epidemics 33 

Scarlet lever in Norwalk, Conn 33 

Diphtheria 34 

Klebs-Loffler bacilli in milk 35 

Summary of epidemics 36 

Outbreak of diphtheria in Dorchester, Milton, and Hyde Park . . 36 

Epidemics of sore throat and pseudo-diphtheria 37 

Character of milk epidemics 37 

( a ) Explosive onset 37 

(b) Disease follows the milk 38 

Elkton epidemic 39 

(c) Special incidence in milk drinkers 40 

( d) The better houses suffer greater invasion 40 

(e) Age and sex 41 

Bacillus carriers 41 

Source of milk contamination 44 

( 1 ) From hands of milker 44 

(2) Air and dust of the stable 44 

(3) Themilkpail 44 

(4) Water supply , 44 

(5) Milk cooler 45 

(6) Cans 45 

( 7 ) Transportation 45 

(8) Distributing dairy 45 

(9) Bottles 46 

Montclair epidemic 46 

Detection of milk epidemics 47 

Prevention of milk epidemics 48 

Points of interest in reporting milk epidemics 49 

Busey & Kober — Summary of epidemics ... r 49 

Milk epidemics 51 

Table L— Typhoid 51 

TaBle II.— Scarlet fever 95 

Table III. —Diphtheria 107 

Table IV. — Sore throat and pseudo-diphtheria 115 

(3) 



Page. 

3. The Milk Supply op Cities in Kelation to the Epidemiology of Typhoid 

Fever (by Leslie L. Lumsden) 151 

Milk and other dairy products as factors in spread of infection 153 

Ways in which the milk may become infected 154 

At the dairy farm 154 

At the dairy 157 

At the grocery 157 

At the home 158 

Determination of milk outbreaks 158 

Measures to prevent the dissemination of the infection of typhoid 

fever L 163 

The prevention of the introduction of infection into milk 163 

The destruction of infection in milk 163 

4. Frequency of Tubercle Bacilli in the Market Milk of Washington, 

D. 0. (by John F. Anderson) 165 

Introduction 167 

Eeview of literature 168 

The number of tubercular cows in the dairies supplying Washington, 

DO < 178 

Eesults of tuberculin tests elsewhere than in herds supplying Wash- 
ington 179 

Characteristics of Rabinowitsch's butter bacillus 180 

Collection of samples and technic 182 

Use of tuberculin to eliminate infection with other acid-fast organisms . 184 

Table of results of autopsies on guinea pigs 184 

Resume 196 

5. The Relation of Goat's Milk to the Spread of Malta Fever (by John 

F. Anderson) 199 

Characteristics of Malta fever 201 

Geographical distribution of the disease 202 

Methods of infection 203 

Epidemiology of Malta fever 203 

Susceptibility of goats to Malta fever 206 

Methods through which the infection is acquired by the goats 207 

Clinical indications of infected animals 208 

Outbreak of Malta fever on the Joshua Nicholson 209 

History of the investigation of the disease at Gibraltar, and preventive 

efforts and legislation 212 

6. Milk Sickness (by George W. McCoy) 215 

Definition 217 

Synonyms „ 217 

Historical . r 21 7 

Distribution 218 

Etiology and pathology 219 

Symptoms 224 

Treatment 225 

Bibliography 225 

7. Relation of Cow's Milk to the Zooparasitic Diseases of Man (by Ch. 

Wardell Stiles) 227 

Remoteness of danger of infection through milk 229 

Methods of possible contamination of the milk with preventive 

measures 229 

Water-borne parasites 230 

Improper disposal of fecal matter , 230 



Page. 

7. Relation of Cow's Milk to the Zooparasite Diseases op Man — 

Continued. 
Methods of possible contamination of the milk with preventive 
measures — Continued. 

Persona] habits 231 

Fecal material from animals 231 

Infections from dogs and cats 231 

8. Morbidity and Mortality Statistics as Influenced by Milk (by J. M. 

Eager) .'. 233 

Quantities of milk consumed 235 

Milk and disease 235 

Statistics of infantile mortality 236 

Diarrheal diseases and milk ' 238 

Mothers' milk and lessened infantile mortality 239 

Infantile mortality, a class mortality. 240 

Scientific artificial feeding and the mortality rate 241 

Milk and tuberculosis . 245 

Milk and typhoid fever . 246 

Scarlet fever and diphtheria . „ 247 

Milk and Asiatic cholera 247 

9. Ice Cream (by Harvey W. Wiley) 249 

Summary of chemical data relating to cream . . . „ 252 

Summary of chemical data relating to ice cream. 253 

Bacteriological investigations of ice cream in the District of Columbia. 255 
The significance of a pure ice cream supply in relation to the public 

health 269 

Definitions and descriptions of ices in trade and other books ........ 273 

Ice cream standard . 284 

The quantity of butter fat in ice cream „ 295 

General conclusions . 297 

10. The Chemistry of Milk (by Joseph H. Kastle and Norman Roberts) . . . 313 

Preface 315 

The composition and general characteristics of milk 316 

Changes in the composition of milk 328 

By the action of heat and acids 328 

Heat and acid coagulation 328 

Effect of heat on milk enzymes... 332 

The digestibility of raw and boiled milk 338 

Effect of heat on enzymes in general 339 

By the action of milk enzymes 342 

By the digestive ferments — the rennin coagulation of milk 348 

By the action of bacteria and other micro-organisms. 359 

The lactic acid fermentation 359 

Abnormal fermentations of milk. 368 

Milk poisons — galactotoxismus 372 

Legal standards governing the sale of milk 377 

United States and State standards 378 

Harwood's views on milk standards 380 

Milk adulterations 381 

Skimming, watering, and the addition of foreign substances ; . . . 381 

Significance of watering in relation to the public health 383 

Artificial coloring matters and milk preservatives 384 

Effect of artificial coloring matters and preservatives on diges- 
tion and health 385 



10. The Chemistry op Milk — Continued. Pa ge. 

The Washington milk supply 396 

Methods of analysis 396 

Conclusions regarding the Washington milk supply 401 

Table I, results of the chemical analyses of Washington milks. . . 405 

Table II, milks below standard and those containing dirt 414 

References to the literature of milk 417 

11. The Number op Bacteria in Milk and the Value op Bacterial 

Counts (by Milton J. Rosenau) 427 

The initial contamination of milk 431 

Legal standards 434 

The practical value of bacterial examinations of milk 435 

Bacterial counts in Washington 437 

Methods 437 

Results tabulated 439 

Results of bacterial counts of market milk in Washington in 1906 

and 1907 439 

Bacterial counts in other cities 449 

Report of committee on bacteriological standards of American Asso- 
ciation of Medical Milk Commissioners 453 

12. The Germicidal Property of Milk (by Milton J. Rosenau and George 

W. McCoy) 455 

Introduction 457 

Examples of the germicidal action 459 

The effect of temperature 460 

Relation to agglutination 470 

Germicidal action compared with that of blood serum 473 

Relation to phagocytosis 474 

Is the "germicidal " action specific ? 475 

The effect of dilution 476 

The effect of heating and freezing 477 

Review of the literature upon the subject 479 

Summary and conclusions 486 

13. The Significance of Leucocytes and Streptococci in Milk (by W. W. 

Miller) 489 

14. Conditions and Diseases op the Cow Injuriously Affecting the Milk 

(by John R. Mohler).. 499 

Importance of a wholesome milk supply „ 501 

Milk from unhealthy cows as a factor in the spread of disease 502 

Tuberculosis 502 

Tubercle bacilli in other dairy products 507 

Value of the tuberculin test 509 

Foot-arid-mouth disease 514 

Actinomycosis 518 

Botryomycosis 519 

Anthrax 519 

Cowpox 519 

Rabies 519 

Mammites mastitis or garget 520 

Leucocytes in milk 520 

Gastro-enteritis • 521 

Milk sickness 522 

Septic or febrile condition 523 

Abnormal appearance and conditions of milk. . . , 523 



14. Conditions and Diseases of the Cow Injuriously Affecting the Milk — Page. 

Continued. 

Slimy, stringy, or ropy milk . , 523 

Bitter milk 523 

Colored milk 524 

Taste and odor 524 

Poisonous milk 525 

Colostrum 525 

Recommendations 525 

15. The Relation of the Tuberculous Cow to Public Health (by E. C. 

Schroeder) 527 

Need of pure milk 529 

Character of tuberculosis as a disease of cattle 531 

Manner in which tubercle bacilli are expelled by tuberculous cattle. 533 

Technic used in demonstrating bovine tubercle bacilli 534 

The appearance of cattle that expel tubercle bacilli 535 

How tubercle bacilli expelled by tuberculous cows get into milk and 

dairy products 537 

The virulence arid vitality of tubercle bacilli in dairy products 540 

The proportion of tuberculous cows among those in use for dairy 

purposes 549 

The frequency with which dairy products have been proven to con- 
tain tubercle bacilli 550 

Summary 553 

16. Sanitary Inspection and its Bearing on Clean Milk (by Ed. H. 

Webster) 557 

Clean milk 559 

What is contamination ? 559 

Sources of contamination 560 

Milk utensils 562 

Cleaning milk utensils 562 

Milk houses _ 563 

Caring for the milk 563 

The city distributing plant 564 

Sanitary inspection of dairies 565 

Directions for scoring dairies 566 

Sanitary inspection of city milk plants 566 

Twenty-one suggestions 570 

The cows 570 

The stables 571 

The milk-house 571 

Milking and handling milk 571 

17. Sanitary Water Supplies for Dairy Farms (by B. Meade Bolton) 573 

Requirements of a sanitary water supply 576 

Sources of water supply 577 

Sources of pollution 578 

Purification of water in the soil 581 

Protection from pollution 582 

Abundance of supply 586 

Convenience of supply 586 

18. Methods and Results of the Examination of Water Supplies of 

Dairies Supplying the District of Columbia (b.y B. Meade Bolton) . 589 

19. The Classification of Market Milk (by A. D. Melvin) 605 

Class 1, certified milk 608 

Class 2, inspected milk 609 

Class 3, pasteurized milk 609 



8 

Page. 

20. Certified Milk and Infants' Milk Depots (by John W. Kerr) 611 

Certified milk 613 

Copy of agreement with dairymen 615 

Organization of the medical milk commissions 620 

Functions of the commissions 621 

Working methods and standards 621 

The standards of purity „ 624 

Regulations for the production of 625 

Results accomplished 628 

Infants' milk depots 629 

Formulae for modified milks 629 

Cities in the United States in which are located infants' milk 

depots 631 

21. Pasteurization (by Milton J. Rosenau) 637 

Introduction 639 

The extent of pasteurization 642 

Laws and regulations concerning pasteurization 643 

Changes in milk produced by heating 646 

Temperature and time of heating 648 

The bacteria and toxines concerned 651 

Infant feeding 656 

Scurvey 658 

Infant mortality 663 

Home pasteurization 665 

Commercial pasteurization 675 

Resume — Advantages and disadvantages 676 

22.. The Thermal Death Points of Pathogenic Microorganisms in Milk 

(by M. J. Rosenau) 681 

Methods 683 

Bacillus tuberculosis 684 

Conclusions 686 

23. Infant Feeding (by Joseph W. Schereschewsky ) 687 

Part I.— Infant mortality 689 

Death rates of various cities 690 

Seasonal fluctuations 694 

Part II.— The infants' dietary 697 

Woman's milk 697 

Cow's milk. 702 

Part III.— Infant feeding 706 

Nutritive requirements of infants 706 

Methods of feeding..., 708 

Maternal nursing 708 

Artificial feeding 715 

24. The Relative Proportion of Bacteria in Top Milk (Cream Layer) and 

Bottom Milk (Skim Milk), and its Bearing on Infant Feeding (by 

John F. Anderson) 737 

25. National Inspection of Milk (by Harvey W. Wiley) 741 

26. The Municipal Regulation of the Milk Supply of the District of 

Columbia (by Wm. Creighton Woodward) 745 

The development of the milk-inspection service 747 

Organization and duties of the milk-inspection service 768 

Supervision and control 771 

Inspection of dairy farms - . = - i ..-...- . 772 



9 

26- The Municipal Regulation of the Milk Supply of the 1 District of Page. 
Columbia — Continued. 

Inspection of dairies 779 

Inspection of milk 780 

Contagious-disease service 783 

Cost of milk inspection 785 

Results of milk-inspection service 786 

Supplementary memorandum government of the District of Columbia. 789 

General Index 831 

Author Index 835 

Serial Publications — Hygienic Laboratory Bulletin 837 



LIST OF ILLUSTRATIONS, CHARTS, ETC. 



Article No. 2. — Milk as a Cause of Epidemics of Typhoid Fever, Scarlet 

Fever, and Diphtheria. 

1. Chart showing typhoid fever cases by ages, in ten-year periods, Stamford, 

Conn., 1895. 

2. Chart showing typhoid fever cases by ages, in five-year periods, Stamford, 

Conn., 1895. 

3. Chart showing number of cases of typhoid fever reported each day during 

the Stamford, Conn., outbreak, 1895. 

4. Diagram I, showing relation of milk routes to fever cases during the typhoid 

epidemic at Stamford, Conn., 1895. 

5. Diagram II, showing relation of milk routes to scarlet fever during outbreak 

at Norwalk, Conn., 1897. 

6. Diagram III, showing relation of milk routes to diphtheria cases during the 

outbreak at Dorchester, Milton, and Hyde Park, Mass., 1907. 

7. Diagram IV, showing relation of milk routes to typhoid fever cases at 

Elkton, Md., in the autumn of 1900. 

Article No. 9. — Ice Cream. 

8. Variations in bacterial content during cold storage of four samples of com- 

mercial ice creams. 

Article No. 12. — The Germicidal Property of Milk. 

9. Chart showing the growth of B. lactis aerogenes in milk at 15° C. 

10. Chart showing the growth of B. lactis aerogenes in milk at 37° C. 

11. Chart showing the growth of B. dysenterise in milk at 15° C. 

12. Chart showing the growth of B. dysenterise in milk at 37° C. 

13. Chart showing the growth of B. typhosus in milk at 15° C. 

14. Chart showing the growth of B. typhosus in milk at 37° C. 

Article No. 15. — The Relation of the Tuberculous Cow to Public Health. 

15. A cow affected with advanced tuberculosis. 

16. Hogs rooting in manure pile adjacent to cow stable. 

17. Three tuberculous cows. 

18. A tuberculous bull. 

19. An exceptionally dangerous tuberculous cow. 

20. A dangerously tuberculous cow. In fat condition. 

21. A dangerously tuberculous cow. Well-kept family cow. 

22. A dangerously tuberculous cow. Apparently well kept. 

23. An exceptionally dangerous tuberculous cow. 

24. Sections of tuberculous udder and lymph gland. 

25. A dangerously tuberculous cow. Under observation two years. 

26. Sections of tuberculous udder and public lymph gland. 

27. A tuberculous dairy cow. Visibly diseased. 

28. A very old and. visibly tuberculous cow. 

(10) 



11 

Article No. 16. — Sanitary Inspection and its Bearing on Clean Milk. 

29. Dirty flanks. 

30. Cleaning cows preparatory to milking. 

31. Dirty stable yard. 

32. Dirty stable yard. 

33. Dirty barn interior. 

34. Dirty barn interior. 

35. Clean barnyard and well lighted barn. 

36. A clean, light, airy barn interior. 

37. A good type of milking suit and pail. 

38. A blind compliance with the regulation as to windows. 

39. Following the letter but not the spirit of the law. 

40. Types of milk pails. 

41. A good type of inexpensive milk house. 

42. The interior of figure 41. 

43. A mere pretense of a milk house. 

44. A dirty, untidy milk house. 

45. A very neat, inexpensive, small bottling room. 

46. A milk room with poorly located tank. 

47. Children washing milk bottles. 

48. Entrance to dairy in basement. 

49. Dairy room in cellar. 

50. A sterilizing oven. 

51. Bottling room in a high-class city dairy. 

52. A modern high-class pasteurizing plant. 

Article No. 17. — Sanitary Water Supplies for Dairy Farms. 

53. Geological formation of artesian wells. 

54. Cesspool not polluting well lower down. 

55. Cesspool polluting well opening above it. 

56. Bad pump surroundings. 

57. Good pump surroundings. 

58. Good well situation in building. 

59. Good natural spring situation. 

60. Bad natural spring situation. 

Article No. 18. — Methods and Results of Examination of Water Supplies 
of Dairies Supplying the District of Columbia. 

61. Field kit. 

62. Shipping box. 

63. Alcohol lamp. 

Article No. 21. — Pasteurization. 

64. Home pasteurizer. 

Article No. 23. — Infant Feeding. 

65. Chart showing deaths from gastro-enteritis in infants, Paris, 1897. 

Article No. 26. — The Municipal Regulation of Milk Supply of the District 

of Columbia. 

66. Bertillon classification applied to cattle. 

67. Chart showing the death rate in the District of Columbia from diarrhea and 

enteritis among children under 2 years of age, 1880-1906. 



1. INTRODUCTION. 



(13) 



Milk and its Relation to the Public Health. 

INTRODUCTION. 



By Walter Wyman, 
Surgeon-General, Public Health and Marine-Hospital Service. 



During the last few years increasing attention has been given to 
milk in its relation to the public health. This is especially true in 
the United States, where the more progressive health authorities of 
the larger cities and many of the States have been instrumental in 
markedly improving their milk supplies. 

The question of sanitary milk is to the American people especially 
pertinent. Milk is perhaps used to a greater extent in this than in 
any other country. It holds a peculiar place in the nation's dietary 
because of its varied applicability. Containing as it does all the 
essentials of a perfect ration, proteids, carbohydrates, fats, inorganic 
salts, and water, it is capable of almost universal use. Because of 
this, and, in addition, its facility of ingestion and comparative ease 
of digestion, it constitutes an important food for the sick and 
convalescent. 

Of even greater importance is the use of cow's milk as a substitute 
for mother's milk in infant feeding. It will be perceived that those 
most dependent upon this food — the sick and convalescent, infants 
and children — constitute that part of the community suffering the 
greatest injury from the use of a food impaired in its nutritive con- 
tent. This is due to the fact that they are least able to resist the 
harmful effects of foods contaminated by toxins or pathogenic micro- 
organisms. While improved conditions of living have contributed 
to a steady decrease of the general mortality in civilized countries, 
this unfortunately does not apply to the infant population under one 
year of age. It is recognized that gastro-intestinal disease is the 
largest single factor determining infant mortality, a condition in 
great measure due to improper methods of feeding. This enormous 
loss of potential wealth is of grave concern to the State and worthy 
of most careful consideration. It is especially for these reasons that 
the question of sanitary milk and its relation to the public health 
challenges our best endeavors. 

The investigation into the origin and prevalence of typhoid fever 
in the District of Columbia during 1906 by a board of medical officers 
of the Public Health and Marine-Hospital Service brought out many 
facts evidencing the possible danger of milk as a carrier of this dis- 
ease, and stimulated investigation and renewed activity in the efforts 
to secure pure milk supply in the District of Columbia. 

(15) 



16 

This investigation and the work of the Department of Agriculture 
concerning the milk supply at the farms were referred to in a letter 
to the President, June 11, 1907, by Dr. G. Lloyd Magruder, of Wash- 
ington, in which it was suggested that the Bureau of Public Health 
and Marine-Hospital Service be directed to make an investigation of 
the milk industry in the District of Columbia from the farm to the 
consumer, with the cooperation of other departments.* 

The Surgeon-General, being called upon by the President for an 
opinion as to whether such an investigation should be made, replied 
affirmatively, with detailed reasons therefor, and with special recom- 
mendations as to cooperation of the several bureaus in the Depart- 
ment of Agriculture, and the President and the Secretary of the 
Treasury thereupon directed the said investigation. 

In order to properly study the subject as it exists in the District 
of Columbia, it was deemed necessary to treat the matter from a 
broad point of View ; that, to study the local aspect of a world-wide 
problem, the findings and experiences of others must necessarily be 
considered. In many respects the Federal Government has peculiar 
advantages for the study of these problems which, strictly speaking, 
are not confined to any one locality, but are national in scope. It is 
therefore incumbent on the National Government to assume its re- 
sponsibilities and attempt the solution of scientific questions of this 
character influencing the lives and health of its citizens. Because of 
the relation the Public Health and Marine-Hospital Service bears to 
the conservation of the public health it was determined to make this 
investigation of such a character that, in addition to being of local 
value, it would also be of assistance to health officers at large, and 
especially to those not as yet provided with the necessary laboratory 
facilities and corps of workers such as can be afforded only by the 
richer and more densely populated centers. 

It has been the object to include in this volume all available data 
showing the influence of milk as a carrier of infection, its chemical 
composition, the contaminations found therein, their influence upon 
it as an article of food, and the measures necessary in its produc- 
tion and handling to prevent such contamination. 

Milk in the udder of a healthy cow is rarely sterile, but with 
proper methods can occasionally be removed in small quantities free 
from micro-organisms. In this condition it may theoretically be 
considered normal milk, and as such has been kept for over two years. 
But this is not the milk of commerce. In the healthy cow, milk may 
contain organisms while still in the udder, or receive its initial con- 
tamination with the omnipresent microphyte in its passage through 
the ducts of the animal's teats. This may be considered its first point 
of contact with the outer world, for these organisms in the healthy 
animal have gained access to the ducts from without. At every other 

°Annual Report, Public Health and Marine-Hospital Service, 1907, p. 35. 



17 

point of contact on its twelve to forty-eight hour journey to the con- 
sumer it receives additional bacteria. 

Milk holds a peculiar position among foodstuffs in that it is an 
excellent medium for the growth of many micro-organisms, both the 
ordinary saprophytic varieties and those pathogenic to man. These 
factors often produce in market milk an enormous bacterial content. 
Zakharbekoff found that in St. Petersburg examination of samples of 
milk as delivered to the houses showed the presence of from 10,200,000 
to 82,300,000 bacteria per cubic centimeter. Samples of market milk 
at Giessen have shown over 169,000,000 per cubic centimeter, New 
York City milk as high as 35,200,000, London milk 31,888,000. In 
Washington, examinations made at the Hygienic Laboratory of the 
Public Health and Marine Hospital Service during the summer of 
1906 showed a maximum of 307,800,000 and an average bacterial 
content of 22,134,289. Were milk transparent, this luxuriant growth 
would be evident to the naked eye, but because of its opacity such 
contamination occurs unnoticed. Fortunately, most of these organ- 
isms are saprophytes, but there are good reasons to believe that they 
may elaborate toxins, rendering milk dangerous as a food. 

It is evident, from a broad view of the subject, that a pure and 
wholesome milk supply is possible, and this volume contains all the 
necessary information to attain that end, as well as the existing stand- 
ards of purity to which it should conform. 

The three cardinal requirements, cleanliness, cold, and speedy trans- 
portation from the cow to the consumer must be observed, and the cow 
herself must be free from disease. For their observance, intelligence 
and care on the part of the dairyman and milk dealer are absolutely 
essential. 

The bearing of all these points upon the wholesomeness of milk, 
its treatment when contaminated, and its use as an article of food, 
especially for infants, has been treated in detail by the various col- 
laborators. To ascertain how serious an indictment might be returned 
against milk as a carrier of disease, a compilation of epidemics pro- 
duced by this means has been made by Doctor Trask. Reports of 
500 epidemics have been abstracted in tabular form and appear in 
the text. These are only the few that have been reported and are 
accessible in the literature ; how small a fraction of all cases this must 
be can only be surmised. 

As a result of large experience, Doctor Lumsden describes how the 
milk supply of cities becomes contaminated with typhoid bacilli, and 
the best epidemiological methods of determining the influence of milk 
as a factor in the propagation of typhoid fever. 

With a view to determining the presence or absence of tubercle 
bacilli in the market milk of Washington, Doctor Anderson examined 

45276°— Bull. 56—12 2 



18 

272 samples from 104 dairies. He found that 6.72 per cent of the 
samples contained tubercle bacilli virulent for guinea pigs, and that 
11 per cent of the dairies whose milk was examined supplied milk 
containing these micro-organisms in sufficient number and virulence 
to render guinea pigs tuberculous. The milk purchased by one 
charitable institution for the use of children caused tuberculosis in 
the animals upon which it was tested. 

Evidence of this character again emphasizes the necessity of apply- 
ing the tuberculin test among dairy herds, and taking necessary pre- 
cautions with respect to milk of doubtful character. 

In a second paper Doctor Anderson summarizes the evidence prov- 
ing that Malta fever may be spread by infected goat's milk. 

A peculiar disease, known as " milk sickness," is described by 
Doctor McCoy. Although fortunately rare at the present time, cases 
continue to occur in the mountainous sections of Tennessee and else- 
where. 

Doctor Stiles shows that so far as the zoo-parasitic diseases of man 
are concerned, there is little to fear concerning the presence of such 
parasites in milk. 

Statistical studies of mortality and morbidity, as influenced by 
milk, have been made by Doctor Eager. He gives figures to prove 
that the high infantile mortality may be attributed almost entirely 
to impure milk. 

Doctor Wiley discusses the subject of ice cream, its use as an arti- 
cle of food, its composition, the extent to which it may be con- 
taminated or adulterated, and the result of such contamination upon 
the public health. He also refers to the established standards govern- 
ing its manufacture, and presents evidence to show their reasonable- 
ness both to the manufacturer and consumer. 

Doctors Kastle and Roberts give a general survey of our present 
knowledge regarding the physical and chemical characteristics of 
milk, as well as the chemical changes in milk brought about by the 
action of heat and acids; and also those changes accomplished by the 
action of enz}^mes and micro-organisms. The subject of milk adul- 
teration is also considered. It has been shown, as the result of origi- 
nal investigations, that the milk ferments can withstand a tempera- 
ture of 60° to 65° C. for some time without material injury. Twelve 
per cent of the samples of Washington market milk examined were 
found to be below the legal standard, 3.7 per cent gave evidence of 
having been watered, and a very large proportion of the samples 
examined contained appreciable quantities of dirt. None of the 
samples examined contained artificial coloring matters, and only one 
contained milk preservatives. 



19 

Doctor Eosenau shows, as a result of many hundred bacteriologic 
examinations of the market milk of Washington made in the 
Hygienic Laboratory, that for the most part it is old, warm and 
dirty. In the summer of 1906 the market milk contained on an 
average of 22,134,289 bacteria per cubic centimeter, and was delivered 
at an average temperature of 16.5° C. During 1907 the average was 
11,000,000 bacteria per cubic centimeter, and temperature 14.2° C. 
The advantages of bacterial counts to the health officer and to the 
practical dairyman are pointed out. 

As a result of original investigations, Doctor Rosenau and Doctor 
McCoy demonstrate the causes of the phenomenon known as the " ger- 
micidal property of milk." They show that the decrease in the num- 
ber of bacteria in fresh milk is for the most part apparent, not real, 
and further that the restraining action of milk can not take the place 
of cleanliness and ice, but may be taken advantage of in good dairy 
methods. 

Doctor Miller reviews the significance of leucocytes and strepto- 
cocci in milk and points out the unsatisfactory state of our knowledge 
concerning their sanitary significance. 

Doctor Mohler points out that probably the most important disease 
of cows from the standpoint of public health is tuberculosis, and that 
it is also the most prevalent. The German commission on tubercu- 
losis found over 10 per cent (6 out of 56) cultures of tubercle bacilli 
of human origin, virulent for cattle. In a similar series of tests con- 
ducted by the British Royal Commission on tuberculosis, 60 cases of 
the disease in the human being were tested with the result that 14 
were claimed by this commission to have been infected from bovine 
sources. It has been found by Schroeder in this country that even 
when tubercle bacilli are not being excreted by the udder the dirt and 
manure of the stables where the diseased animals are kept are in many 
cases contaminated with tubercle bacilli. This contaminated material 
may readily infect the milk even though it comes from a healthy cow. 
In a recent examination at the Bureau of Animal Industry, Experi- 
ment Station, of the manure passed by 12 cows purchased from dairy 
farms in this city and infected with tuberculosis to an extent only 
demonstrable by the tuberculin test, tubercle bacilli were found in 
over 41 per cent of the cases. 

Mohler estimates that probably 25 per cent of all the cows which 
supply milk to the District of Columbia are tuberculous. He fur- 
ther points out the great practical value of the tuberculin test and in- 
sists that all milk should come from either tuberculin tested cattle or 
be subjected to pasteurization under the supervision of the Health 
Department in case the herd is not tuberculin tested, 



20 

Mr. Webster, among other things, emphasizes the value of the score 
card in the sanitary inspection of dairies and its bearing on the pro- 
duction of- clean milk. He also gives 21 very useful suggestions con- 
cerning the cows, stables, milk houses, and methods of milking and 
handling milk. 

Doctor Bolton writes of the dangers from contaminated water sup- 
plies on dairy farms and shows that a pure water supply on the farm 
appears to present much fewer difficulties than the same problem in 
towns. Each supply presents its own problem which must be solved 
for itself, with proper recognition of the objects to be aimed at, and 
these are purity, abundance, and convenience. 

Doctor Bolton also gives the methods and results of the examination 
of the water supply of dairies supplying the District of Columbia. 
The analysis of results seems to show that there are comparatively few 
water supplies on the dairy farms visited which are free from sanitary 
objection, but in spite of this fact it is nevertheless probable that in 
many or most cases the faults can be rectified with little expense. 

Doctor Melvin offers a practical solution of the classification of 
market milk. He proposes three grades : (1) Certified milk ; (2) in- 
spected milk, and (3) pasteurized milk. 

Doctor Kerr gives a brief outline of the organization and conduct 
of medical milk commissions in the United States, established to 
foster the production of " certified milk." Emphasis is laid on the 
fact that the plan was formulated by a physician, and that it contem- 
plates the sanitary supervision of dairies by a commission appointed 
by the local medical society for the purpose of producing pure milk 
especially for the use of infants and invalids. In this paper are 
included copies of the first contract entered into between a medical 
milk commission and a dairyman ; also the requirements of the milk 
commission of the medical society of the county of New York, which 
contain all of the essential rules required by other commissions for 
the production of pure milk. 

It appears that this movement has been a potent factor in improv- 
ing the character of the milk supply in various parts of the country, 
as it has required that only tuberculosis-free cattle should be used 
for the production of milk, that their milk should be cooled to a 
temperature of 45° F. and transported in a manner so that it reaches 
the consumer before noticeable biological or chemical changes have 
occurred therein. He also refers to the founding of infants' milk 
depots in the United States, and presents in tabular form the num- 
ber of such organizations and other pertinent information relating 
thereto. 

The important subject of pasteurization has been carefully studied 
by Doctor Eosenau, who points out its advantages and discusses its 



21 

inconveniences. He recommends 60° C. for twenty minutes as the 
best temperature to use in pasteurizing milk, as this degree of heat 
is sufficient to destroy the pathogenic micro-organisms without de- 
vitalizing the milk itself. While pasteurization is not the ideal to 
be sought, practically, it is forced upon us by present conditions. 
It prevents much sickness and saves many lives — facts which justify 
its use under proper conditions. It is recommended that in large 
communities at least, pasteurization should be under direct supervi- 
sion of the health authorities. 

The trend of our modern knowledge upon the important subject 
of infant feeding is stated in Doctor Schereschewsky's article on this 
subject. The importance of breast feeding is emphasized. It is 
shown that the caloric needs of the infant must be considered in 
order to insure success in artificial feeding. Some of the errors of 
formula feeding are pointed out, and stress is properly laid upon 
the disastrous results which frequently ensue from overfeeding, espe- 
cially with excessive amounts of butter fat. Schereschewsky believes 
that there is no relation between the heating of milk and infantile 
scurvy, and shows how this disease may result from qualities in the 
milk, other than those resulting from heating. 

In the last three articles named, as well as elsewhere in this bulle- 
tin, references will be observed to the achievements of Mr. Nathan 
Straus in promoting the use of clean pasteurized milk for infants 
and the establishment of infants' milk depots both in the United 
States and abroad, and it is proper here to give recognition to his 
philanthropic and successful efforts. 

Doctor Woodward describes the municipal regulation of the milk 
supply of the District of Columbia. He recounts the history of the 
development of the milk inspection service, which consists of super- 
vision, inspection of dairies and dairy farms, and inspection of the 
milk. It is shown that these measures have resulted in the improve- 
ment of the milk supply, and that there has been a notable reduction 
of morbidity following their inauguration. 

The laws and ordinances governing the supervision of milk are 
given, and in addition copies of the forms of reports, etc., which are 
of value to those having supervision of milk supplies. 

Acknowledgments are here made to Doctor Woodward and the 
officers of the Bureaus of Animal Industry and Chemistry for their 
hearty cooperation and contributions upon this important subject. 



22 

A SECOND EDITION. 

The first edition of this bulletin, which was issued January, 1908, 
has been of great value to health officers and others interested in 
improved milk supplies, as is shown by the enormous and constant 
demand throughout the world for copies. It was abstracted by 
Mr. Nathan Straus, and the abstracts were generously distributed 
by him throughout Europe in connection with his propaganda for 
safe milk. 

The first edition has long since been exhausted, and it therefore 
becomes necessary to publish a second edition. On account of the 
short time since the first edition appeared and the character of some 
of the data relating to the investigation, especially that contained in 
the statistical tables, it has been impracticable to include the corre- 
sponding statistics for the year 1908. The limitations of the volume 
have prevented the inclusion of chapters relating to certain milk 
products, although discussion dealing with butter, dried milk, pre- 
pared milk, and milk substitutes would be of value. It is expected 
that these subjects will be given consideration in later publications. 

Important chapters added in this edition include a discussion of 
the relationship of the tuberculous cow to public health, by Dr. E. C. 
Schroeder, of the Bureau of Animal Industry. In this article, 
Doctor Schroeder invites attention to the manner in which tubercle 
bacilli are expelled by tuberculous cattle, the technique used in 
demonstrating bovine tubercle bacilli, the ways in which tubercle 
bacilli expelled by tuberculous cows get into milk, and the dangers 
involved therein. 

In a chapter on the thermal death point of pathogenic micro-organ- 
isms in milk, Surg. M. J. Rosenau concludes that the heating of milk 
to 60° C. for twenty minutes is sufficient to destroy the tubercle 
bacillus, the diphtheria bacillus, the cholera vibrio, the dysentery 
bacillus, and the Micrococcus melitensis. He also refers to recently 
enacted laws relating to pasteurization, discusses home pasteuriza- 
tion, and gives directions for its employment. 

Passed Asst. Surg. John F. Anderson, in a new chapter, deals with 
the relative proportion of bacteria in top milk and bottom milk, and 
its bearing on infant feeding. 

Dr. H. W. Wiley, Chief of the Bureau of Chemistry of the Depart- 
ment of Agriculture, has also contributetd an additional chapter on 
the national inspection of milk. 

It is a pleasure to acknowledge the interest shown in this publica- 
tion, as well as again express appreciation to Doctor Woodward 
and the officers of the Department of Agriculture for their coopera- 
tion in the preparation of this work. 



2. MILK AS A CAUSE OF EPIDEMICS OF TYPHOID 
FEVER, SCARLET FEVER, AND DIPHTHERIA. 



(23) 



2. MILK AS A CAUSE OF EPIDEMICS OF TYPHOID FEVER, 
SCARLET FEVER, AND DIPHTHERIA. 



By John W. Trask, 
Passed Assistant Surgeon, Public Health and Marine-Hospital Service. 



That milk may play a part in the spread of certain diseases has, 
for many years, been appreciated. From our present knowledge the 
more important of these are typhoid fever, scarlet fever, diphtheria, 
and possibly tuberculosis. 

Milk, from the time it leaves the cow's udder, receives from its sur- 
roundings bacteria of various kinds. Certain of these organisms come 
from the teats of the cow and the dust and dirt of the stable, and are 
possibly in most cases harmless; others come from the hands of the 
milker and those handling the milk, and from the pails and cans used 
for milking, storage, and transportation. During the last fifty years 
there has been piling up a mass of evidence which would seem to show 
that milk may receive from man the specific organisms of certain 
infectious diseases, and that these organisms may retain their viru- 
lence for some time and produce the disease in susceptible individuals 
drinking the raw milk. Many epidemics supposedly spread in this 
way have been reported in the literature since 1857. Compilations of 
these cases have been made by Hart a in England, Schlegtendal & in 
Germany, Car0e c in Denmark, and by Busey d and Kober, e R. G. Free- 
man f and H. B. Baker s in this country. 

Up to 1895 Hart, and Busey and Kober had collected 240 such epi- 
demics. In addition to these, there are here presented 260 compiled 
from the literature and from special reports. (I desire here to 
ackowledge the great assistance rendered by the many health officers 

a Hart (E.), Transactions Internat. Med. Cong. London, 1881, IV, 491, also 
Brit. Med. Jour. Lond., 1897, 1, 1167, 1229, and 1292. 

& Schlegtendal, Deut. Vierteljahrschr. f. Offentl. Gesundheitspflege, 1900, Bd. 
XXXII, 287. 

c Car0e (K.), Ugeskrift for Laeger, Kobenhavn, 1898, 5 R., V, p. 1009. 

d Busey (S. C.) and Kober (G. M.), Report of Health Officer of District of 
Columbia, 1895, p. 299. 

e Kober ( G. M. ) , Senate Doc. 441, Fifty-seventh Congress, 1st session. 

f Freeman (R. G.), Medical Record, N. Y., 1896, XLIX, 433. 

9 Baker (H. B.), Annual Report Michigan State Board of Health, 1896. 

(25) 



26 

and other physicians who so kindly responded to the circular letter 
sent out by the Surgeon-General requesting reports of milk epi- 
demics.) The 90 epidemics compiled by Car0e have not been in- 
cluded because of lack of time and space. No attempt has been made 
to note every outbreak reported as spread by milk ; many cases where 
the evidence did not seem entirely convincing have been omitted. 
Necessarily much of the evidence upon which it is determined 
whether or not an epidemic is conveyed by milk is circumstantial; 
the same may be said of water-borne disease, and indeed of many of 
the things in daily life which we firmly believe. In an explosive 
outbreak of an infectious disease, to find that all persons attacked 
had used one milk supply, that they had apparently nothing else in 
common, that no cases occurred except among users of this milk, and 
then to isolate from the milk the specific organism of the disease in a 
virulent state, is believed to be good evidence in the absence of other 
explanation. It is not to be inferred that this has been taken as an 
absolute standard up to which all epidemics must come before being 
considered as spread by milk, for to do this the outbreak would have 
to occur in a locality previously entirely free from the disease and 
the development of secondary-contact cases, which is necessarily a 
common occurrence, would wrongly exclude such epidemics. Then, 
too, the difficulty of isolating the Eberth bacillus when in small 
amount and accompanied by large numbers of other organisms and 
our lack of absolute knowledge as to its specificity, and the fact that 
no organism has as yet been isolated which is commonly accepted as 
the causal agent of scarlet fever, would lead to erroneous conclusions 
if the isolation of a specific organism were insisted upon. 

TYPHOID FEVER. 

Schuder a in 1901 collected from the literature 650 typhoid epi- 
demics the supposed cause of which had been reported. Four hun- 
dred and sixty- two were reported as spread by water, 110 by milk, 
and 78 by all other means. This places milk second only to water as 
a carrier of typhoid infection. But the ratio of 462 to 110 probably 
by no means shows the true relation of water and milk as producers 
of such outbreaks. Schiider's epidemics were collected mainly from 
continental Europe, where milk epidemics are apparently not as com- 
mon as in England and America, due possibly to the more or less cus- 
tomary practice in Europe of using pasteurized or cooked milk. The 
result of such a compilation as the above may also have been affected 
by the fact that until comparatively recently water has received 
much more attention in typhoid epidemiological work than has milk. 

«SchMer, Zeitschrift f. Hyg. und Infectionskrankheiten, 1901, XXXVIII, 
p. 343. 



27 

It is evident that Schuder did not include in his list the approxi- 
mately 90 typhoid epidemics collected by Car0e.° These occurred in 
Denmark between 1878 and 1896, and were reported as in all prob- 
ability due to milk. It is also apparent that he did not include the 
combined milk typhoid epidemics collected by Hart, and Busey and 
Kober, 138 in number, which had been previously compiled. 

Undoubtedly the relative importance of the various agencies by 
which typhoid fever is distributed varies with the locality and condi- 
tions. The various factors, water, milk, flies, and contact, have dif- 
ferent values in the city and in the town. They will naturally also 
vary in importance with the season, the latitude, and the local cus- 
toms. Improved water supplies have eliminated water as a factor 
in many places, while regulation of the production, handling, and 
sale of milk is lessening its influence for harm in some communities. 
It would seem that water has been so apparent as a frequent carrier 
of the infection that other agents have not been looked for, or at least 
not commonly found, until improved water supplies had demon- 
strated that there were other factors at work. The experience in 
Massachusetts has been given by Harrington 6 as follows : 

In the public mind outbreaks and epidemics of this disease (typhoid) are 
commonly associated with polluted drinking water, but when water supplies 
are properly guarded, as in Massachusetts, for example, they are more com- 
monly found to be caused by contaminated food, and especially by that one 
which is most subject to pollution and which offers the specific organism the 
most favorable conditions for preserving its virulence and increasing its num- 
bers — namely, milk. During the past two years, of 18 local outbreaks of 
typhoid fever in different parts of Massachusetts investigated under my direc- 
tion, 14 were traced to milk. 

Jensen c also makes the statement : 

The principal means by which typhoid fever is distributed in places where 
there is a safe and hygienic water supply is through milk. 

BACILLUS TYPHOSUS IN MILK. 

V. C. Vaughan^ reported in 1890 the isolation of a bacillus from 
the water of a dairy well, and from the milk sold by the dairy. There 
had been one or more cases of typhoid in the family of the milkman, 
and one or more cases existed in every family patronizing this dairy. e 
The bacillus was highly pathogenic to white rats and guinea pigs. 
It was nonliquefying and toxicogenic. The bacillus resembled but 

«Car0e (K.), Ugeskrift for Laeger, 1898, V, p. 1009. 
6 New York Med. Jour., 1907, p. 697. 
c Essentials of Milk Hygiene, English ed., 1907, p. 106. 

a Vaughan (V. C), Ann. Report State Board of Health, Michigan, 1891, p. 216. 
eVaughan (V. C), Trans. Seventh Internat. Cong, of Hyg. & Demography, 
1891, Vol. Ill, Section III, p. 121. 



28 

was not identical with that of Eberth. When the use of the milk was 
discontinued the outbreak ceased. 

Dr. A. R. Reynolds, then commissioner of health of Chicago, stated 
in 1902 that although special search had been frequently made during 
the last eight years the typhoid bacillus had been found in Chicago 
city milk only three times, and then in cases of local epidemics, and 
that in 1902 the presence of the typho-colon group of bacilli had 
been repeatedly demonstrated. 

Konradi & isolated the typhoid bacillus from milk in 1905. In 
Kolozsvar there was an unusual number of cases of typhoid. (See 
Table of epidemics.) The water could in no way be connected with 
the increase, and attention was attracted to a bake shop from which 
many cases seemed to originate. The typhoid bacillus was isolated 
from a sample of milk taken from this bake shop. Proper precau- 
tions were immediately taken against this shop and its milk, and the 
number of cases of typhoid fell in the next month back to the usual 
average number. He also examined 32 other samples of milk and 
isolated the typhoid bacillus from one taken from a dairy where the 
farmer's son had a mild attack of typhoid fever which was not severe 
enough to keep him from working and milking the cows. 

Shoemaker reports an outbreak of milk typhoid in Philadelphia 
in October, 1906. He states: 

A culture made from the milk proved the presence of the typhoid bacillus 
in it. 

A visit to the dairy revealed that the proprietor and one of his 
servants were ill with typhoid and that — 

the son was convalescing from typhoid fever and was filling the milk bottles 
from a tank by siphonage, starting the flow by sucking with the mouth at one 
end of the tube. A culture made from this end of the tube revealed many 
typhoid bacilli. 

Cautley d infected milk with the typhoid bacillus and recovered the 
bacillus after seven days. In his summary he states : 

The typhoid bacillus will live in milk under the conditions that ordinarily 
prevail in a household. When this bacillus has been artficially added in large 
amount to milk in the condition in which it commonly reaches the consumer, 
the presence of the microbe in the living state may be demonstrated after the 
milk thus treated has been kept several days. * * * It will also live in 
milk which has turned sour at the temperature of the room in which it is kept. 

o Reynolds (A. R.), Chicago Medical Recorder, 1902, p. 222. 
& Konradi, Centralbl. f . Bakt. etc., 1 Abt, Bd. 40, p. 31. 
c Journal Am. Med. Assn., May 25, 1907, p. 1748. 

a Cautley (Edmund), Report Med. Officer, Local Govt. Board, London, 1896-97, 
p. 243. 



29 

Broers a demonstrated the ability of the typhoid bacillus to live in 
milk and butter for from two to three weeks. 

Bruck in 1903 & took ordinary market milk and infected it with 
the bacillus typhosus. He then ran the milk thus treated through 
a separator and found the viable organism persisting in the cream 
for ten days after separation. Butter made from this cream showed 
the presence of the viable bacillus for twenty-seven days. The bacil- 
lus typhosus could be recovered from the buttermilk for ten days. 
Pfuhl c showed the ability of the Eberth bacillus to persist in market 
milk for thirteen days and in butter for twenty-four days. 

Eyre d undertook experiments to demonstrate the growth of the 
typhoid bacillus in milk. To avoid the false ideas arising from the 
use of the sterilized product, he drew the milk from a healthy cow 
under aseptic conditions and gives the following results showing the 
possible rate of increase: 





hours. 


2 hours. 


4 hours. 


6 hours. 


8 hours. 


12 hours. 


24 hours. 




78 


50 


42 


42 


46 


460 


6,000 






This shows a decrease for the first few hours, due to the germicidal 
action of fresh milk. In another case the count showed the following : 




hours. 


24 hours. 


48 hours. 


7 days. 




78 


60, 000 


10, 300. 000 


440. 000. 000 





















SUMMARY OF EPIDEMICS. 

Of the 179 typhoid epidemics reported as spread by milk, compiled 
by the writer, 107 occurred in the United States, 43 in Great Britain, 
23 in continental Europe, 3 in Australia, 1 in New Zealand, and 2 in 
Canada; all cases enumerated in the outbreak were reported as living 
in houses supplied with the suspected milk in 96 of the epidemics; a 
case, suffering from the disease at such a time as to have been the pos- 
sible source of infection, was found at the producing farm, distrib- 
uting dairy, or milk shop in 113 cases; the outbreak was supposed to 
have been due to bottles returned from infected households and re- 
filled and distributed without previous sterilization in 4 cases; the 

° Broers (C. W.), Nederlandsch. Tijdschrift voor Geneeskunde, 1904, XL, p. 
1260. 

6 Bruck, Deut. Med. Woch., 1903, XXIX, p. 460. 

« Pfuhl, Zeit. Hyg., 1902,- XL, p. 555. 

<*Eyre (J. .W.), Jour. State Med., London, 1904, XII, p. 728. 



30 

diseased person or persons were mentioned as handling the milk or 
milk utensils in 2; the sick milked the cows in 6; the same person 
nursed the sick and handled the milk or milk utensils in 6; same 
person was mentioned as nursing sick and milking cows in 10; ice 
cream was given as the infective medium in 3 ; whipped cream in 1 ; 
typhoid dejecta were reported as thrown on the ground in such a way 
as to have more than probably contaminated the well water used for 
washing the milk utensils in 4 ; in many cases mention was made of 
special incidence of the disease among persons in the habit of drinking 
milk; the Eberth bacillus was isolated from the milk in 1 case (Kon- 
radi) ; it was reported that measures taken upon the presumption that 
milk was the cause of the epidemic, and looking to the removal of 
this as a factor, were followed by abatement of the outbreak after 
due allowance for the usual period of incubation from the distribu- 
tion of the last infected milk in 78 of the cases. 

The following is an example of a typhoid epidemic apparently due 
to milk : 

STAMFORD EPIDEMIC, APRIL 15 TO MAY 28, 1895.* 

Stamford, Conn., a town of 15,000 population, had for some months 
been comparatively free from typhoid fever. During the nine days 
following April 14, 1895, 160 cases were reported in addition to 24 
noted as suspicious. One hundred and forty-seven out of the 160 and 
all of the suspected cases had used milk delivered by one dairyman, 
B. Between April 15 and May 28, 386 cases living in 160 houses were 
reported. The dairy was closed April 21, and on May 6, just fifteen 
days after the sale of milk was stopped, the outbreak had practically 
subsided. (See charts 1, 2, and 3.) 

Of the 386 cases 352 (91.2 per cent) lived in houses taking milk 
from dealer B., 12 were known to have used this milk at a cafe sup- 
plied by him, 2 obtained it at a bake shop selling the same milk, and 
2 obtained it in other ways, making 368 cases so traced or 95.3 per 
cent. (See diagram I.) Eight cases were supplied directly by a 
producer, E. B. L., who produced the bulk of the milk peddled by B. 
This makes 376, or 97.1 per cent, connected with this milk supply. 
Of the other cases 4 were supplied by one dealer, 5 were supplied by 5 
different dealers, and 1 could not be connected with any milk supply. 
It was estimated that 3,000 quarts of milk were peddled daily in 
Stamford, of which B. supplied about 275 quarts. He therefore 
supplied about one-eleventh of the milk and had 95.3 per cent of 

a Smith (Herbert E.), Connecticut State Board of Health Report, 1895, pp. 
161-179, 



CHART I. 
SHOWING IN TEN-YEAR PERIODS THE AGES OF CASES DURING THE STAMFORD OUTBREAK. 

AGES 

Under 10 Years I 10T02.0 20 to 30 30 to ^o 40T0 50 over 50 




J. 



NOTE THE UNUSUAL NUMBER OF CASES UNDER 10 YEARS OF AGE AS COMPARED WITH 
THOSE BETWEEN 20 AND 30 YEARS, THE PERIOD USUALLY MOST SUSCEPTIBLE TO 
TYPHOID. 



CHART 2. 
SHOWING IN FIVE-YEAR PERIODS THE AGES OF CASES DURING STAMFORD OUTBREAK. 



UND6R AGES OVER 

5Yt/\ps StolO 10-15 15-2.0 7.0-2.5 25-30 30-35 35-40 40-45 45-50 50 




LLl 

h 

k tr- 
ee O 
< o. 

I ^ 

o Q= 



CO 



LJ 




o 


in 


o 


ir> 


o 


ir> 


o 


in 


*• 


*r 


IO 


ro 


cvi 


oi 



S19VD 



EXPLANATION OF DIAGRAM I. 



The large square M N O P represents the town of Stamford. 

B is the dairy distributing the implicated milk, and the dash lines 
running from B into the city represent the milk route of this dairy. 
Each of the dots represents one case of typhoid fever and is placed 
upon the route of the dairy from which it was supplied with milk. 
There are 368 such cases on B's route, including the 12 around the 
[~S~1, which is meant to represent the cafe supplied by B. B supplied 
about one-eleventh of the milk used in the town. 

H H and H are distributing dairies similar to B. 

C H and E B L are producing farms selling milk to B and also 
peddling some themselves. The dash line extending from E B L 
represents his personal route of 5 houses in which 8 cases of typhoid 
occurred. 

J H B and J B H are producing farms selling milk to B and also 
to distributing dairies H and H H. 

The double lines show the dairy to which the producer sold most 
of his milk. 

Dash lines show the apparent course of the infective agent. 

C, D, E, F, and G are other dairies having routes in Stamford. 



DIAGRAM I. 

SHOWING RELATION OF MILK ROUTES TO TYPHOID FEVER CASES DURING THE EPIDEMIC 
AT STAMFORD, CONN., 1895. 




31 

cases. B. obtained the milk sold by him from other parties and pro- 
duced none himself. He was supplied regularly by 3 producers, 
E. B. L., C. H., J. B. H., and after April 12 also by J. H. B. C. H. 
besides furnishing milk to B. also supplied some in town himself, and 
among his customers only one case occurred. J. B. H. produced 4 
cans of milk a day ; one can went to B. ad 3 cans to dairyman H. H., 
on whose route occurred only 5 cases of typhoid. E. B. L. furnished 
B. from 140 to 150 quarts of milk daily; this constituted over one- 
half of B.'s supply. In fact, all that E. B. L. produced went to B., 
except a few quarts which he distributed to 5 families. It is signifi- 
cant that in these 5 households there were 8 cases of typhoid. 

B.'s dairy was situated in a low, poorly drained part of the city. 
The water used to wash cans was from an uncemented dug well with 
a loose board cover 6 inches above the ground level. The well was 
13J feet deep and the water stood within 1 foot 9 inches of the top. 
There was a shallow, foul privy 25 feet west of the well on slightly 
higher ground, and another 40 feet to the east. The water supply 
was therefore a shallow surface well, uncemented, in poorly drained 
soil and in close proximity to two privies. Chemical and bacterio- 
logical examination of the water showed gross pollution. The last 
act in the washing of milk cans by B. was to rinse them in cold well 
water and invert them to drain and dry. The next morning these 
cans were taken to the producing farms for use. B.'s method of 
delivery was such that there was no part of his route which might 
not have received milk from the E. B. L. farm. B. washed all the 
cans coming to him and returned them clean to the producers. 
Farmer C. H. scalded the returned cans before refilling. E. B. L. 
refilled the cans just as they came from B., all of his milk going into 
them, including that which he delivered to his 5 personal customers. 
J. B. H. refilled cans returned from B. without any extra treatment. 
He had, however, in use 8 cans, one of which was returned daily from 
B., and 3 taken to H. H. No precautions were taken to keep separate 
the cans coming from the two dealers. J. H. B. did not begin to 
furnish milk to B. until after the outbreak was well started and H., 
who handled most of his milk, had only one case on his route. 

No case of typhoid was found at the dairy or producing farms, 
but the hypothesis that the well water at dairy B. was infected would 
explain all the features of the epidemic, and whatever the source of 
the infection the fact remains that the disease followed the milk of 
this one dairy, B., and of that distributed to the 5 houses personally 
supplied by E. B. L. 



32 

B. supplied about 225 households in which 352 cases occurred, a 
cafe among the frequenters of which 12 cases developed, a bakery in 
whose patrons 2 cases were found, and 2 other fever patients were 
reported who had obtained this milk in other ways. 

SCARLET FEVER. 

No organism has as yet been isolated which is generally accepted as 
the specific cause of scarlet fever. In 1882 Mr. W. H. Power a in- 
vestigated an outbreak diagnosed as scarlet fever which he believed 
was caused by infectious matter from a cow which had recently 
calved. In 1885 Power 6 investigated another epidemic which was 
practically limited to users of milk from a certain dairy at Hendon 
where several diseased cows with an eruption of the udders were sup- 
posed to have been the source of the infection. Klein c isolated 
from the lesions in the cows and also from human cases a micrococcus 
which he believed to be the specific organism of the disease and prob- 
ably the cause of scarlet fever. This view has not been accepted. 
Sir George Brown,** who also investigated this outbreak, was of 
the opinion that the cow disease was possibly vaccinia, and that the 
milk had probably become infective by contact with a human case. 
Other similar outbreaks have subsequently occurred among cows 
without a corresponding epidemic among the users of the milk. - 

In the scarlet fever outbreaks which appear later, the abstracts 
were made from the reports cited, and the writer is aware that in a 
few of the cases the evidence is not entirely conclusive. In two of 
the cases the source of the infection is given as supposedly diseased 
cows. This is necessarily an opinion of the reporter and not a state- 
ment of fact, and these outbreaks have been included because the 
association of the disease to milk distribution was such as to make it 
probable that the milk, if not the carrier itself, stood at least in some 
relation to the carrier of infection, whatever the original source 
might have been. 

a Power (W. H.), Report of Local Govt. Board, Lond. (Medical Officer's 
Supplement), 1882, p. 65. 

& Power (W. H.), Report of Local Govt. Board, Lond. (Medical Officer's 
Supplement), 1885, p. 73. 

c Report of Local Govt. Board, Lond. (Medical Officer's Supplement), 
1887-88, p. XIII. 

d Report on Eruptive Diseases of the Teats and Udders of Cows in Rela- 
tion to Scarlet Fever in Man, Agricultural Department, Privy Council Office, 
London, 1888. 



33 

SUMMARY OF EPIDEMICS. 

Of the 51 scarlet fever epidemics reported as spread by milk, com- 
piled by the writer, 25 occurred in the United States and 26 in Great 
Britain ; all cases enumerated in the outbreak were reported as living 
in houses supplied with the suspected milk in 27 of the epidemics ; a 
case suffering from the disease at such a time as to have been the pos- 
sible source of infection was found at the producing farm, the dis- 
tributing dairy, or milk shop in 35 cases ; the outbreak was supposed 
to have been due to bottles returned from infected households and 
refilled without previous sterilization in 3 cases ; the diseased person 
or persons were mentioned as handling the milk or milk utensils in 3 ; 
the sick milked the cows in 12 ; the same person nursed the sick and 
handled the milk in 1; same person nursed sick and milked cows in 
1; the outbreak was supposed to be due to disease of the cow in 2; 
it was reported that measures taken upon the presumption that milk 
was the cause of the epidemic were followed by abatement of the out- 
break in 22 cases. 

The following outbreak is one of many interesting illustrations: 

SCARLET FEVER IN NORWALK, CONN.° 

In November, 1897, an unusual number of cases of scarlet fever 
occurred in Norwalk. Population of Norwalk, South Norwalk and 
East Norwalk, 22,000. Previous to October 25 scarlet fever had 
been reported as follows: August, no cases; September, 5 cases; Oc- 
tober 10, one case. The source of infection in most of these cases 
had been traced. Between October 25 and November 9, 29 cases 
developed. The 29 cases were distributed in 25 families and 24 
houses. School infection was eliminated. Many cases did not at- 
tend school, and some were in families where they had no school 
children. The cases were widely separated; 17 of the infected 
houses were in South Norwalk, 3 in Norwalk, and 4 in East Nor- 
walk. The families were of different social positions and contact- 
infection seemed improbable. The only factor in common to prac- 
tically all of the cases was the milk supply. Twenty-seven out of 
the 29 obtained milk from one dealer, H. The other two were in 
one family in East Norwalk; they were a girl of 12 and boy of 9 
years, and were taken ill on November 7 and 9, respectively. They 
had no connection with the milk route, nor could their infection be 
traced to any source. 

a Smith, (Herbert E.) ; Report Connecticut State Board of Health, 1897, p. 259. 
45276°— Bull. 56—12 3 



34 

The estimated daily supply of milk in Norwalk was 3,500 quarts. 
Dealer H. furnished 450 quarts, or about one-eighth of the whole, 
whereas he had twenty-seven twenty-ninths of the scarlet fever 
cases on his route. 

H. bought his milk from three producers. There were no cases 
of disease in the family of the milk dealer nor in those of two of 
the producers, A. and B. but on the third producing farm, K., a case 
of scarlet fever was found. This farm was in the Bald Hill dis- 
trict. The district school had opened September 7 with a registra- 
tion of 23 pupils. On September 20 one of the pupils fell ill with 
scarlet fever; other cases followed, and the school was closed Octo- 
ber 19. In all there were 20 cases, all in school children or in those 
coming in contact with them. Two of the above cases, living near 
farm K., were exceedingly mild and frequently visited and played 
at this farm with K.'s son, a lad of 4 years. This son broke out with 
a scarlatinous rash October 24. 

Milk from this farm was carted to Norwalk and all of it sold to, 
and delivered by, dealer H., who placed the cans of milk from K. in 
his wagons with that from the other two producers, A. and B. No 
attempt was made to keep the cans separate, and, therefore, one day 
part of his customers might receive K.'s milk and the next day it 
would be delivered to others. H. supplied about 300 families, of 
which 24 were invaded. The sale of this milk was stopped Novem- 
ber 7. The number of cases and the dates on which they occurred 
would indicate that the milk was not continuously infected. Dur- 
ing the outbreak several cases of sore throat occurred among users 
of H.'s milk, which may possibly have had some casual relation to 
the infectious milk. 

It would seem that cases of scarlet fever belonging to a school 
outbreak and visiting a dairy farm, and possibly also the boy on the 
farm, infected from his playmates, were the source or sources ren- 
dering the milk infective. The relation here of the two outbreaks 
is of interest, the one spread by school contact being the original 
source of the milk epidemic. 

DIPHTHERIA. 

Diphtheria epidemics apparently due to milk began to be reported 
in 1877 and 1878 in England. In certain cases the suspected milk 
came from herds where cows were found suffering from an eruptive 
disease of the udder, and this was thought to be the source of the in- 
fection. In this connection Klein a conducted some experiments on 
cows with the Klebs-Lomer bacillus. He took healthy milch cows 
and inoculated them subcutaneously in the shoulder with 1 cubic cen- 
timeter of a broth culture of the Klebs-Lomer bacillus taken from a 

° Klein, Report Med. Officer, Loc. Govt. Board, London, 1889, p. 167. 



EXPLANATION OF DIAGRAM II. 

A, B, and K are dairy farms selling their product to retail milk 
dealer H. K is the farm on which a case of scarlet fever occurred 
antedating the outbreak in Norwalk. 

The large square TOWN represents the city of Norwalk. 

H is the retail milk dealer among whose customers all cases but two 
occurred. The dash lines represent H's milk route, and each dot is a 
case of scarlet fever. 

C, D, E, F, G, I, and J are other dairymen having routes in Nor- 
walk. The lines extending from them into the city represent their 
milk routes and are introduced to show their freedom from the 
disease. 



DIAGRAM II. 

SHOWING RELATION OF MILK ROUTES TO SCARLET FEVER CASES DURING OUTBREAK 
AT NORWALK, CONN., 1897. 








35 

human case. These cows became ill, had a rise in temperature, and 
on the fifth day there appeared upon the udder an eruption character- 
ized by papules, vesicles^ and crusts. He states that he isolated the B. 
diphtheriae from the vesicles, pustules, and milk. Other experiment- 
ers a 6 have however failed to get similar results. The Klebs-Loffler 
bacillus has been isolated from market milk by Bowhill, Eyre,<* 
Klein, 6 and Dean and Todd/ 

KLEBS-LOFFLER BACILLI IX MILK. 

Dean and Todd reported that in certain families supplied with 
milk from two cows there occurred 2 cases of clinically typical diph- 
theria and 3 of sore throat, that in one family using the milk only 
after sterilization no case occurred. Inspection of the cows showed 
papules, crusts, and ulcers on the teats and udders. One of the cows 
seemed well and gave apparently normal milk; the other had a 
mammitis and gave a scanty, ropy, semipurulent and slightly blood- 
tinged milk. Cultures were made from the throat of one of the diph- 
theria patients and also from the ulcers and milk of each cow, and 
typical Klebs-Loffler .bacilli were isolated in all cases. The milk of 
the cow with mammitis also contained streptococci. The bacillus 
isolated was virulent and markedly pathogenic to guinea pigs, but 
diphtheria antitoxin protected guinea pigs against large doses. The 
udder eruption was shown to be contagious to cows and capable of 
spread by the hands of the milker, but no B. diphtheriae were found 
in vesicles and ulcers of the secondary bovine cases. Calves were not 
protected from this disease by diphtheria antitoxin, nor by this dis- 
ease from cowpox. The conclusions drawn were that the ulcers on 
the udders had become secondarily infected with B. diphtheria?, 
probably accidentally from some apparently healthy throat, and that 
the udder affection was a separate disease. 

Eyre 9 has shown the ability of the B. diphtheria? to proliferate in 
raw milk drawn from the cow under aseptic conditions as follows : 



B. diphtheriae. 



hours. 



24 hours. 



48 hours. 



1,170 22,000 19,000,000 



7 days. 



Abbott (A. C), Jour. Path. & Bact, 1894, II, p. 35. 

6 Ritter, Centralblatt f. Bakt, Referat, 1896, XIX, p. 662. 

c Bowhill, Veterinary Record, 1899, April 8th. 

d Eyre, Brit., Med., Jour., 1899., II, p. 586. 

e Klein, Journal Hygiene, Camb., 1901, I, p. 85. 

f Dean & Todd, Jour. Hygiene, Camb., 1902, II, p. 194. 

fi'Eyre, loco citato. 



36 



SUMMARY OF EPIDEMICS. 

Of the 23 diphtheria epidemics reported as spread by milk and 
compiled since 1895, 15 occurred in the United States and 8 in Great 
Britain; cases of the diseases occurred at the producing farm, dis- 
tributing dairy or milk shop at such a time as to have been the possi- 
ble cause of the outbreak in 18 cases; the diseased person milked the 
cows in 4 ; the same person nursed the sick and handled the milk in 
1 ; the outbreak was supposed to be due to disease of the cows in 2 ; 
all cases of the disease were reported as living in households supplied 
with the suspected milk in 15 instances; measures taken upon the 
presumption that milk was the carrier of infection were reported as 
followed by subsidence of the outbreak in 5 cases; the Klebs-Loffler 
bacillus was isolated from the suspected milk in 2 of the epidemics. 

The following outbreak is one of many interesting examples : 

OUTBREAK OF DIPHTHERIA IN DORCHESTER, MILTON, AND HYDE PARK. 

On April 13, 1907, after a period of comparative freedom from 
diphtheria, there were reported to the board of health of the town of 
Milton 11 cases of that disease. This sudden explosion caused very 
naturally a feeling of grave apprehension on the part of the local 
health authorities. The following is an account of the epidemic: 
Cases of diphtheria were reported in Milton as follows: April 12, 1 
case; 13, 11 cases; 14, 1 case; 15, 4 cases (of these 4 cases, 3 were 
in the same house and secondary to a case which had developed be- 
fore the 12th and can therefore be considered as not belonging to this 
explosive outbreak) ; 16, 1 case. In Dorchester cases were reported 
as follows: April 12, 6 cases; 13, 19 cases; 14, 11 cases. In Hyde 
Park the number and dates were: April 13, 2 cases; 14, 5 cases; 15, 6 
cases ; 16, 1 case ; IT, 3 cases, and 19, 1 case. 

The following table shows the relationship of the cases in the differ- 
ent places: 





Place. 


April. 


Total by 




11. 


12. 


13. 


14. 


15. 


16. 


17. 


18. 


19. 


towns. 







1 
6 


11 

19 
2 


1 

11 
5 


4 


1 








18 




36 


Hyde Park 




6 


1 


3 




1 


18 












Total 




7 


32 


17 lft 


2 


3 




1 


72 


1 









a Monthly Bulletin, State board of health, Mass., May, 1907, vol. 2, No. 5, 
p. 117. 



EXPLANATION OF DIAGRAM III. 



JH, EBN, ETT, OH, JMB, and CF J are the farmers pro- 
ducing milk. 

A is the milk dealer delivering milk in both Milton and Dorchester. 
B is the milk dealer delivering milk in Hyde Park. 

The lines connecting the producing farms and the milk dealers 
show to which dairy the farmer sold his milk. 

The large squares represent Milton, Dorchester, and Hyde Park. 

The dash-lines extending from A to B into the towns represent the 
milk routes carrying the supposedly infectious milk. 

Each dot represents a case of diphtheria and is placed on the 
milk route from which it was supplied. 

C, D, E, F, G, and H represent the other dairies selling milk. The 
lines extending from them into the towns represent their routes and 
are inserted to show their freedom from diphtheria cases. 



DIAGRAM III. 

SHOWING RELATION OF MILK ROUTES TO DIPHTHERIA CASES DURING THE OUTBREAK 
AT DORCHESTER, MiLTON, AND HYDE PARK, 1907. 










••« 










. 


. 






o 




i 


• 


» • 






/ 


1 

i __ 


fc 






g 


/ 






i 















Dorchester 













t. 




(d 






1 • 

1 


o e o o e 






• • • o 


—fcl 


• 


• • % e • 







lak 





Hyde Park 










V 


• • • » 




\ 


i • • • • 


1 W 




!• 

, • • « • 






• • • • 


E 









37 

Investigation showed that all the cases in Dorchester and Milton 
were supplied with milk by one dairy, A, with the exception of 3 
which were all in one house in Milton and were secondary to a case 
reported before the onset of the outbreak. In Hyde Park all the cases 
obtained milk from dairyman B. Dairy A bought its milk from 6 
producers : J H, E B N, E T T, O H, J M B, and C F J (see diagram 
III). On none of the producing farms were any cases of diphtheria 
found except on that of C F J, where it was discovered that a child 
had been seized with the disease on April 11, and that the cooler in 
which the milk was mixed was washed in the house and that this 
office was performed by the person who had the care of the sick child. 
This same producer, CFJ, also sold about one-third of his output to 
dairyman B, who delivered it in Hyde Park. Prompt action on the 
part of the local authorities in excluding sale of milk produced by 
CFJ, brought the outbreak to an immediate close. 

It will be noticed from the table that the outbreak in Hyde Park 
occurred a day later than that in Dorchester and Milton. This is 
explainable by the fact that B called for his share of C F J's milk in 
the evening and sold it on the following day, whereas A came for his 
in the morning and disposed of it at once. 

It is of further interest that CFJ himself came down with the dis- 
ease after the outbreak had nearly subsided, and that dealer A's son 
who drank milk from CFJ was one of the earliest victims. 

EPIDEMICS OF SORE THROAT AND PSEUDO-DIPHTHERIA. 

Among the collected epidemics are 7 variously reported as sore 
throat, pseudo-diphtheria and septic sore throat. They all occurred 
in Great Britain. Two of the outbreaks were supposed to be due to 
milk coming from cows having mastitis, 4 to milk of cows afflicted 
with teat and udder eruption ; in one case the sequence was first severe 
sore throat, thought to be quinsy in the farmer, followed by mastitis 
in the cows and sore throats in other persons on the farm, and last an 
outbreak of sore throats on the milk route. Precautions taken 
against the milk were reported as stopping four of the outbreaks. 

CHARACTER OF MILK EPIDEMICS. 

Milk epidemics have characteristics more or less peculiar to them- 
selves and usually show the following features : 

(a) Explosive onset. — The onset is usually sudden and may very 
aptly be termed explosive. This is due to the fact that a certain can 
or lot of milk receives an amount of the infective material from con- 
tact with an infectious person, premises, or water. This milk may be 
delivered to the consumers by itself, in which case the number of 



38 

persons exposed to the infection is small. Or it may be mixed in a 
dairy with that from many other cans, and thus a larger amount of 
more dilute infectious material be delivered to the community. If 
kept cool, the milk may remain thus dilute as regards the pathogenic 
organism and the disease may crop out among the consumers only in 
those most susceptible or in persons drinking a comparatively large 
amount. But if the milk becomes warm because of lack of care or 
long transit and the contained organism is such that it will prolif- 
erate in milk, each quart delivered to the consumer may be more 
infectious than the original can. In either case the users of the 
infectious milk will receive their dosage of the organism at approxi- 
mately the same time and will therefore, making due allowance for 
the normal variations in period of incubation, fall ill simultaneously. 

The initial explosion may therefore consist of but a few cases if 
the amount of infected milk is small or if very dilute; or of many 
if the amount of infected milk is large or the number of organisms 
great. If the milk is infected at but one milking, the outbreak will 
rapidly subside and, aside from secondary cases spread by contact 
or other means, no new ones will appear. If the milk is infected 
day after day, the outbreak continues; and in contagious diseases, 
after the lapse of the period of incubation from the initial outbreak, 
secondary cases due to contact are apt to appear and grow more 
numerous, so that the picture presented of a typical milk epidemic 
may become less clear. A milk epidemic is therefore most typical 
in its onset, although under efficient systems of notification and quar- 
antine secondary contact cases may be largely prevented and it may 
then maintain its characteristics throughout. The development of 
these secondary cases contracted by contact and otherwise explains 
why in the epidemics reported later in tabular form not all of the 
cases in the outbreak are reported as consumers of the suspected 
milk. Another explanation is that in most cities there are always 
a certain small number of cases of the commoner contagious diseases 
which have varied sources of origin and may be termed residual. 
It is on top of this as it were that an epidemic occurs. 

(b) Disease follows the milk. — Disease carried by milk can occur 
only among users of the infectious milk. Milk routes may therefore 
at times be considered thoroughfares of infection. During an epi- 
demic other cases of course may occurr among nonconsumers, but 
the contagion is carried to these by other means. In typhoid fever 
for example it is possible to conceive a water and a milk epidemic 
occurring at the same time, or what is possibly more common in 
the cities, during an unusual prevalence of typhoid due to various 
and in some cases unknown causes, smaller milk outbreaks may occur. 

° Bull. No. 35, Hyg. Lab., U. S. Pub. Health and Mar.-Hosp. Serv., Wash., p. 20. 



39 

But milk epidemics necessarily follow the milkman, and often his 
route can be plotted by the incidence of the disease. The outbreak 
may be limited to a certain section of the city if the route is small 
and circumscribed in extent. This will usually eliminate water as 
a cause of typhoid where a public supply is in use. Or where various 
water supplies are used the cases may occur among the users of the 
different sources. If the dairy is a large one, delivering to all parts 
of the city, the cases may be widely separated and much scattered, 
having nothing in common but the milk supply. The children may 
go to different schools, the families be of varied social status. These 
points will usually eliminate schools and contact as sources. 

At times where the area covered by the milk route and therefore the 
district involved in the outbreak is circumscribed, occasional isolated 
cases will be found at a distance, and upon careful investigation it will 
be found that they had friends or relatives on the involved route and 
used the suspected milk while on a visit. 

Very interesting cases have been reported where the evidence seemed 
quite convincing of persons drinking a single glass of the suspected 
milk and falling ill after a due period allowed for incubation. 

Milk outbreaks are as a rule more typical in small towns where the 
organization is less complicated and fewer extraneous factors occur 
to conceal the true picture. An example of this is the outbreak at Elk- 
ton, Md., in 1900. 

Elkton epidemic." — Elkton had a population of 2,542. The town 
water supply was obtained from the Elk River about 1J miles above 
the town. Part of the families drank the town water, the rest used 
private wells. The inhabitants were supplied with milk from 4 dairy 
farms having routes in the town. Dairyman B on his way to town 
each day with his own milk obtained an additional amount from 2 
other farmers, C and D, both of whose farms remained free from 
typhoid. In September, 1900, a case of typhoid fever occurred on 
farm A (see diagram IV) adjoining farm B. Mrs. B, wife of the 
dayman, assisted in nursing the case at A for two or three weeks up 
to October 5. For some days before this Mrs. B and one of her sons 
had been ailing, but the boy continued milking and the mother han- 
dling the milk up to October 8, when both became too ill to work. 
(Later another son fell ill.) Previous to this time there had been in 
Elkton only 3 cases of typhoid and they were all in one family, oc- 
curring August 12, September 12 and September 19. On October 11, 
3 cases of typhoid fever were reported; 12, 1 case; 13, 2 cases; 14, 
3 cases; 15, 3 cases; 16, 3 cases; 18, 6 cases. By October 28, 32 fam- 
ilies had been invaded. All used milk supplied by B, 18 used the 

Fulton (John S.) Jour. Hyg., Camb., 1901, 1, p. 422. 



40 

town water supply, and 14 private wells. The total number of cases 
was 39. On this day B stopped selling milk and in three weeks the 
epidemic subsided. The final summary of the outbreak was: In- 
vaded houses, 39 ; all used B's milk, 21 used public water supply, and 
18 used private wells. B claimed to supply regularly 80 houses with 
milk. One hundred and eighty people lived in the 39 invaded house- 
holds. 

There were several occurrences during this outbreak of special 
interest. Miss M, living in New Jersey, visited Elkton for two days, 
October 5 and 6, returning home on the 7th. While in Elkton she 
was at a house supplied with milk from B's farm. No typhoid had 
occurred at this house up to that time. On October 14 Miss M fell 
ill with typhoid. In one family a negro servant, whose chief food 
consisted of oatmeal and milk, left Elkton the middle of October and 
went to Glasgow, Del., where she became ill of typhoid and died. In 
another family was a married daughter who left Elkton the last of 
October to visit friends. In about ten days she fell ill with typhoid. 
At the jail where there were from 15 to 20 prisoners who received no 
milk whatever, 3 members of the jailer's family, and 2 men assisting 
about the place, all of whom used B's milk in one form or another, 
fell ill with typhoid, while the prisoners were not attacked. 

In cities where large dairies are the rule, receiving milk from per- 
haps hundreds of farms some of which are situated miles away, it is 
necessarily very difficult at times to find the infecting focus. Cases of 
the disease may occur on two or three milk routes, and search will show 
that they all receive part of their milk from the same farm or else that 
one dairyman at times sells surplus milk to the others, but the milk 
consumed will all be directly or indirectly traced to some common 
source of contact of disease with the milk. In tracing the relationship 
between milk and the disease, ice cream and other forms of milk prep- 
arations such as whipped cream are to be borne in mind. A confec- 
tioner's shop or bakery may be the focus producing an epidemic. 

(c) Special incidence in milk drinkers. — In addition to the fact that 
as a rule cases occur only in houses using the infectious milk, many 
times interesting incidents occur where in a family the only person 
attacked will be one drinking raw milk, or where the only person 
exempt will be the sole one not using it. Usually cases are found 
mainly among the milk drinkers. 

(d) The better houses suffer greater invasion. — The so-called better 
class of houses are often attacked in greater proportion than others. 
This is explained by the fact that families with larger incomes are sup- 
posed to drink more milk, whereas those with lesser resources use it 
mainly in tea or coffee or cooked in food preparations and for children. 



EXPLANATION OF DIAGRAM IV. 

Each red dot represents a case of typhoid fever. 

A — Farm where original case occurred in September and was 
nursed by wife of farmer B. 

B — Dairy farm where wife nursed preceding case and prepared 
the milk for market. She and one son were ailing for some days but 
did not stop work until October 8. 

The dash-lines represent the course and distribution of the milk 
from farm B. All the cases of typhoid were on this milk route. 

C and D were farms selling milk to farmer B. No typhoid oc- 
curred on these 2 farms. 

E — Farm receiving a small amount of milk daily from B for use of 
girl staying at farm. This girl contracted typhoid. 

F, G, and H — The 3 other dairy farms supplying milk to Elkton. 
The solid lines represent their routes. No case of typhoid on these 
routes. 

Population of Elkton 2,542 

Total cases 64 

Houses invaded 39 

Invaded houses using B's milk 39 

Invaded bouses using well water IS 

Invaded houses using town water 21 

The large square — " TOWN " — represents the town of Elkton. 



DIAGRAM IV. 
SHOWING RELATION OF MILK ROUTES TO TYPHOID FEVER CASES AT ELKTON, MD., 1900. 



N 



E [J] 









E\ 


pE 


1 






i-m 


• •••••• 






j • 

• • 

• * 
i • 
i • 

t * 


• 


. ] 


















Q 


b 




( 


Y 




} 


^ 



w 



41 

Among the well to do therefore it frequently happens that infectious 
milk finds more victims, while among the poor the children are the 
ones most likely to suffer. 

(e) Age and sex. — Women and children are usually credited with 
drinking more milk than men, and it is generally believed that a 
greater incidence of the disease in them is a characteristic of milk- 
borne outbreaks. 

BACILLUS CARRIERS. 

The term " bacillus carrier " is most commonly associated with 
carriers of typhoid or Klebs-Loffler bacilli, and is used to designate 
persons who discharge the former in their feces or urine, or both, or 
harbor Klebs-Loffler bacilli in their nose or throat. They may be 
acute or chronic carriers depending on whether they carry the organ- 
isms for short or long periods of time. 

Diphtheria carriers may become such from having had an acute 
attack of the disease, or by associating with others having acute 
attacks, or with other bacillus carriers. Klebs-Loffler bacillus carriers 
have undoubtedly frequently infected milk, and thus produced epi- 
demics of milk diphtheria. This in all probability is more likely 
to happen when the carrier is a milker at a dairy farm. 

Typhoid carriers are of particular interest because it has been 
found that an appreciable number of typhoid convalescents dis- 
charge typhoid bacilli in the urine or feces, or both, and that from 
2 to 4 per cent continue to do so and become chronic typhoid bacillus 
carriers, that some continue so for years and some during the re- 
mainder of their lives. It is now known that not only may convales- 
cents become carriers, but that nurses and those coming in contact 
with the sick or with other carriers may in turn become typhoid ba- 
cillus carriers for longer or shorter periods of time and that, at times, 
without themselves falling victims to the disease. 

Undoubtedly these bacillus carriers constitute one of the important 
factors in the spread of typhoid fever by milk. Individuals in the 
ear]y stages of typhoid may be physically well enough to continue at 
work milking or handling milk; others with very mild attacks may 
not cease work at all. Both may be discharging typhoid bacilli in 
the excretions. On the other hand, the chronic typhoid bacillus car- 
riers may continue to discharge bacilli not only for weeks but for 

C W. T. Graham, C. L. Overlander, John E. Overlander, and M. A. Dailey 
found 23 per cent. (Boston Med. and Surg. Journ., Jan. 14, 1909.) Officers 
of the medical and sanitary departments of the Government of India at the 
Central Research Institute at Kasauli found 11.6 per cent. ( Scientific Memoirs, 
No. 32, "An enquiry on enteric fever in India," p. 7.) 



42 

years, and being well, remain at work and continue a menace over 
long periods of time. 

When it is considered that available evidence seems to show that 
between 2 and 4 per cent of typhoid convalescents become chronic 
bacillus carriers, the probability that some of them are employed at 
dairies in milking cows and handling milk is very great. 

Several epidemics, due to milk infected by these chronic typhoid 
bacillus carriers, have been reported. Others will undoubtedly be 
found with increasing frequency as epidemics are studied with this 
possibility in mind. 

Dr. Henry Albert reports a small but interesting outbreak of this 
kind occurring in the autumn of 1907 at Cedar Falls, Iowa : 

A certain gentleman had typhoid fever a year ago and recently 4 cases of 
typhoid fever developed in his own family, 7 in the family of one neighbor and 
2 in the family of another neighbor. The man who had typhoid fever a year 
ago owned a cow, did his own milking, and supplied milk to the 2 families in 
which the cases, respectively, 7 and 2, developed. The man who is supposed to 
be the source of this infection is apparently perfectly well, but has a slight cysti- 
tis and on the examination of his urine, typhoid bacilli were isolated. The 
water used by this man and his family came from a rather shallow well. It 
contained a large number of Colon bacilli, but no typhoid bacilli were found. 
This water was, however, not used by any member of the other 2 families. 
Just how the bacteria gained entrance to the milk, whether from the hands of 
the bacillus carrier or from the water used for cleaning milk pails, is difficult 
to determine, but it seems very certain that the milk was the medium through 
which the infection of the 9 cases in the neighboring families was carried. 

Branthwaite reports an outbreak at Brentry Reformatory, an in- 
stitution for the detention and treatment of habitual inebriates. The 
reformatory consisted of 16 buildings, scattered over about 98 acres 
of ground. The institution was practically isolated from other com- 
munities and housed usually about 265 persons. It ran its own dairy. 
From 1899 to 1906 the institution remained free from infectious dis- 
eases. The first case of typhoid occurred in September, 1906, and by 
November, 1907, 28 cases had developed. The patients fell ill at 
irregular intervals and always in groups of from three to five. The 
first patient was a woman who had been in the institution several 
months, and therefore removed from the possibility of outside in- 
fection. Careful search was made as to the possible introduction of 
the disease, but in spite of all precautions others continued to be 
attacked. A detailed investigation pointed to the milk as the carrier 
of infection. All milk had been regularly sterilized, and therefore 
if it were the cause it was necessarily due to defective methods or 
to subsequent contamination. A new sterilizing plant was installed, 
and all handling of milk after heating was limited to two persons, a 



43 

man and a woman. But still cases developed, and all evidence con- 
tinued to point to the milk. It was therefore concluded that infec- 
tious material reached the milk after sterilization, and it was decided 
to find whether one of the two persons handling it was a bacillus 
carrier. The woman milk handler was removed from the dairy and 
her feces examined. Pure cultures of the typhoid bacillus were 
isolated from her stools. She was permanently removed from the 
dairy, and, after a lapse of the usual incubation period of two weeks, 
no new cases had developed up to the time of the report, three months 
later. 

Dr. A. JL Chalmers, medical officer of health of Glasgow, Scot- 
land, reported an outbreak in Glasgow in December, 1907, and 
January, 1908. This outbreak is of interest because of the parts 
played by a bacillus carrier and an acute case of typhoid fever in the 
production of the epidemic. There were 126 cases of typhoid, in all 
of which the patients obtained milk from one dairy. Eight of the 
patients sickened between December 5 and 14. One of these 8 cases 
developed at Parkhouse dairy farm, which supplied milk to the dis- 
tributing dairy from which all the other patients obtained their milk. 
Then for four days there were no cases. Following this, between 
December 19 and January 13, 93 cases developed. The result of 
much careful work in studying the relationship of the milk distri- 
bution to the incidence of the disease showed that the Parkhouse 
farm was the undoubted source of infection, and while the acute 
case which developed there could, from a standpoint of time and 
opportunity, have been the direct cause of the 93 and more cases 
which formed a typical milk epidemic, and undoubtedly was the 
cause, yet there remained to be found the source of infection of the 
first 8 cases, of which this patient was one. The water supply of 
the farm could not be found at fault, and so an investigation was 
made of the dairy hands. There was found an elderly woman milker 
who gave a history of having been previously associated with out- 
breaks of typhoid fever. She had had the disease sixteen years 
before. Her stools were examined and the typhoid bacillus isolated. 
Her blood gave a positive Widal reaction with ' ; the laboratory strain 
of the typhoid bacillus." The conclusions drawn were that this 
woman was the source of infection of the first 8 cases occurring be- 
tween December 5 and 14, one of which developed on this same farm 
in a woman who was ill from December 7 to 24, when her case was 
diagnosed as typhoid fever, and that this latter case was the source 
of infection causing the typical milk outbreak between December 19 
and January 13. 



44 

Kayser, in 1905, reported two small milk outbreaks of typhoid 
fever traced to chronic bacillus carriers as the source of infection. 

SOURCE OF MILK CONTAMINATION. 

(1) From hands of milker.— -Many dairy employees take no pre- 
cautions to keep the hands clean, and in fact the milker who washes 
his hands before milking is the exception and not the rule. He may 
be a typhoid bacillus carrier and be discharging typhoid bacilli in the 
excretions, and any carelessness in toilet is apt to deposit bacilli on 
the hands and under the finger nails. In the act of milking it is 
more than likely that he will wash at least some of them into the milk 
pail, and especially so if he resorts to a custom, all too common, 
of moistening his hands by squirting milk upon the palms pre- 
liminary to milking. 

The milker's hands may have become soiled in acting as nurse 
for some case of typhoid in the family. He may be a convalescent 
from scarlet fever and be shedding particles of epidermis into the 
milk, or he may have diphtheria, or possibly tuberculosis, and with 
every act of sneezing and coughing spray tubercle or Klebs-Loffler 
bacilli with particles of sputum. If he does, as is not entirely un- 
known among careless milkers, and moistens his hands by spitting 
into the palms to facilitate the action of the fingers upon the teats, 
it is easily seen how infective material may find its way into the milk. 

(2) Air and dust of the stable. — The stable dust may contain 
organisms eliminated by those working in it, and as some of this 
dust and other stable refuse adhering to the flanks, buttocks, and 
udders of the cows and floating in the air finds its way into the milk, 
under the conditions sometimes employed, it may carry with it these 
organisms. 

(3) The milk pail. — The milk pail may have been washed and 
taken care of by some person or member of the family suffering from 
a contagious or infectious disease and in the handling have received 
its quota of typhoid or other bacilli which thus find their way into 
the milk. 

(4) Water supply. — The water supply of the farm or dairy may 
be at fault. Farms are often very unfortunate in the location of their 
wells, which very frequently become polluted by cases of typhoid on 
the premises. The privy vaults are at times not far distant and are 
apt to be leaky and subject to seepage, and when a case of typhoid 

°A further discussion of the subject of bacillus carriers and epidemics due 
to them will be found in the chapter on " The milk supply of cities in relation 
to the epidemiology of typhoid fever." 



45 

fever occurs on the place or a person eliminating the bacilli sojourns 
temporarily on the premises, the possibility of water contamination 
exists. In some cases the dejecta of typhoid patients are buried in 
shallow holes around the house and often unwittingly around the 
well, while at other times, as occurred in some of the epidemics 
reported later, the dejecta were simply thrown on the ground where 
they could easily find their way into the water supply. Pails washed 
in polluted water, if not afterwards scalded, may contain the infect- 
ive material and the more so if some of the last rinsing water still 
remains in them. The possibility of this water being added directly 
to the milk need not be considered, although it has undoubtedly 
played an important part in some epidemics. The water used may 
be a stream into which some household higher up empties its sewage. 
It has been supposed that cows wading into polluted streams might 
get upon the udders contaminated water, which in the act of milking 
would find its way into the pail. This at least is one of the rarer 
means of infecting milk. 

(5) Milk cooler. — If a milk cooler is used and not properly taken 
care of, infectious material may reach the milk through it. 

(6) Cans. — If the milk is then put into cans the same possibilities 
are again met as in the pails. 

(7) Transportation. — If the milk is now shipped to a distributing 
dairy in the city there is always the possibility of its infection in 
transit by those handling it, and it must always be borne in mind that 
some person may surreptitiously dip into the container with a soiled 
vessel or dipper or even drink from the mouth or top of the can. 

(8) Distributing dairy. — Then there are the receptacles used by 
the retailer. In many distributing dairies the milk comes in by train 
in large cans, and before the contents are poured together in the mixer 
each can of milk must be tasted to ascertain whether or not it is sour. 
One man usually does the tasting. It may be done in a manner free 
from criticism or the taster may tip each can before it is lifted from 
the wagon and, removing the top, place his mouth to the can and taste 
the milk. When milk has been treated in this manner it has at times 
been the custom to draw into the mouth a sufficient amount and then 
spit it upon the ground. One taster has been mentioned who was so 
economical that he returned the tasted milk to the can. Another 
means of tasting which has at times been employed is to use a spoon 
or small dipper, inserting it into one can after another, and of course 
between cans into the mouth of the taster. A method less subject to 
criticism is to tip each can, then removing the cap, taste of the milk 
adhering to it. The cap can then be cast aside and scalded before 



46 

further use and the milk emptied intojhe mixing tank. Other meth- 
ods entirely free from criticism are commonly used by careful dairies. 
(9) Bottles. — It is at present the custom to deliver milk to the 
consumer in bottles. This is especially so in the cities. It can be 
seen how this practice properly operated may be better than any 
other ; but, on the other hand, if carelessly conducted may be a source 
of much danger. Clean milk in sterile, well-capped bottles, handled 
and delivered by clean men, free from disease, is a condition much to 
be desired. But where empty bottles returned from the consumers' 
bouses are not properly scalded before being again filled, the possi- 
bility of contamination by pathogenic organisms is necessarily con- 
siderable. Bottles left at houses where there are cases of scarlet fever, 
typhoid, or diphtheria, if refilled without being properly scalded, are 
undoubtedly a source of much danger. Many cities have ordinances 
to prevent this, but the constant presence of mild cases of disease, so 
mild and, according to present standards, atypical, that a correct 
diagnosis is not made, renders all regulating measures more or less 
ineffective. The accidental infection of bottles in an orderly, well- 
regulated household need not be considered so long as certain classes 
of people persist in using them for various other purposes, such as 
urinals and receptacles for sputum. Dr. Herbert Fox, chief of the 
laboratories of the Pennsylvania state department of health, states: 

The attention of the commissioner of health, Dr. Samuel G. Dixon, was 
called to a slimy mass of material on the under surface of a milk-bottle cap. 
He sent this to the laboratory and it was received in a very dry condition. 
Upon softening down and smears made from it we were able to obtain suffi- 
cient proof that it was sputum. Doctor Dixon informs me that he has known 
of milk bottles used for cuspidors on more than one occasion. 

The practice of drinking directly from the bottles is a habit that 
must also be borne in mind as a possible means of contamination 
with tubercle and Klebs-Loffler bacilli. An example of apparent 
bottle infection is found in the typhoid outbreak at Montclair, N. J., 
in 1902. 

Montclair epidemic. — During the summer and autumn of 1902 
there was only an occasional case of typhoid in Montclair. The 
1st of December several cases occurred, apparently having milk from 
one dairy as the only factor in common. Investigation of the farms 
producing this milk failed to reveal any cases of disease which could 
be the source of the infection. All persons coming in contact with 
the milk were apparently in good health. More careful examination 

<* Ninth Annual Report, Board of Health, Town of Montclair, N. J., 1903. 



47 

of the invaded houses showed that cases of typhoid existed only in 
those houses receiving milk in pint bottles. There were no cases 
among the quart-bottle customers. Cases continued to be reported 
on this route and the sale of milk from the dairy was therefore 
stopped. After two weeks new cases ceased to develop. It was then 
found that a man from New York City had come to Montclair ill 
with typhoid fever and had remained for a few days at a house sup- 
plied with milk from this dairy until he could be removed to a hos- 
pital. This house had during the patient's stay been supplied daily 
with three pint bottles of milk. The empty bottles were removed 
daily and, without sterilization, refilled and delivered to other 
houses. It seemed that this was the means of spreading the disease. 
Eighteen cases occurred in Montclair and 10 in Bloomfield, all in 
houses supplied with milk in pint bottles from this dairy. 

Pathogenic organisms may possibly reach the milk through dust 
while in the care of the vendor, but most likely the vendor himself is 
the more important and that, while organisms floating in the air can 
undoubtedly settle into milk, yet the chief danger is from contact 
with diseased persons or those having an intimate relation with the 
sick. 

DETECTION OF MILK EPIDEMICS. 

When in a city an unusual number of cases of scarlet fever, diph- 
theria, or typhoid fever occurs among the customers of any one dairy, 
it may be considered a sufficient reason for causing a careful inquiry 
to be made and a search for some source of milk infection. The mere 
finding of cases on one milk route is not by any means conclusive 
that milk is the carrier of the infection, but it is sufficient to cast 
suspicion and at times, undoubtedly, also to warrant regulation, even 
if no source of contamination is found, for it is often exceedingly 
difficult to find the infective focus. 

The health officers of many cities have for some time been charging 
each case of typhoid fevor, scarlet fever, and diphtheria to the dairy- 
man supplying the milk to the invaded household. In this way it 
is apparent when an unusual number occurs on one route, and meas- 
ures can be taken to ascertain whether the incidence of the disease 
has an etiologic relationship to the milk. Cases which otherwise 
would show no relationship to each other are revealed as associated, 
and the milkman makes neighbors of families separated by consider- 
able distance. In the complicated life of cities this gives the health 
officer a valuable aid in the control of certain of the common in- 
fectious diseases. 



48 

PKEVENTIOtf OF MILK EPIDEMICS. 

Inspection and regulation of the production, handling, and sale of 
milk will lessen the number of milk epidemics. In cities the proper 
charging of each case of scarlet fever, diphtheria, and typhoid fever 
to the dairy on whose route it occurs will often reveal milk outbreaks, 
which can then be suppressed before reaching too great proportions. 
The most rigid inspection and regulation practicable at the present 
time, however, are impotent to prevent chronic bacillus carriers from 
being employed on milk farms and at dairies. They are also unable 
to keep mild ambulant cases of infectious diseases from being so en- 
gaged, for the reason that such cases can often not be diagnosed until 
after other cases have developed. Soper's case ° of " Typhoid Mary " 
was a constant danger in her capacity as family cook to the members 
of the family in which she happened to be employed and to visitors 
eating of the salads and food prepared by her, but what might have 
happened had she been employed in the handling of milk distributed 
over a large city route can only be surmised. 

The only way to prevent these epidemics entirely would appear to 
be to pasteurize or sterilize the milk, either at the dairy before de- 
livery to the consumer or in the household after delivery. 

a Soper ( George A. ) , Jour. Am. Med. Assn., June 15, 1907, p. 2019. 



49 

POINTS OF INTEREST IN REPORTING MILK EPIDEMICS. 

In reporting milk epidemics some of the points of special interest 
are the following : 

1. The number of cases of the disease existing in the involved ter- 
ritory during the time covered by the epidemic. 

2. The number of houses invaded by the disease. 

3. The number of invaded houses supplied in whole or in part, 
directly or indirectly, by the suspected milk. 

4. The number of cases occurring in invaded houses so supplied. 

5. The number of houses supplied with the suspected milk. 

6. The relative proportion of houses so supplied to those supplied 
by other dairies. 

7. The time covered by the epidemic. 

8. The location of the case or cases from which the milk became 
contaminated. 

9. The relation of the original case to the milk. 

10. The time relation of the original case to the epidemic. 

11. The special incidence of the disease among milk drinkers. 

12. The elimination of other common carriers of infection. 

13. The effect upon the epidemic of closing the dairy or taking 
such measures as will eliminate possibility of milk contamination 
from the suspected focus. 

14. The finding of the specific organism in the milk. 

BUSEY AND KOBER'S SUMMARY OF EPIDEMICS. 

Busey and Kober summarized the epidemics compiled by them as 
follows : 

TYPHOID-FEVER EPIDEMICS. 

Mr. E. Hart tabulated 50 epidemics of typhoid fever and we have collected 
88, making a total of 138 epidemics traceable to a specific pollution of the 
milk, the main facts of which are presented in a subjoined table. In 109 in- 
stances there is evidence of the disease having prevailed at the farm or dairy. 
In 54 epidemics the poison reached the milk by soakage of the germs into the 
well water with which the utensils were washed and in 13 of these instances 
(Nos. 5, 24, 39, 45, 70; 89, 90, 98, 99, 103, 111, 116, 124), the intentional dilution 
with polluted water is admitted. In 6 instances (Nos. 10, 74, 104, 107, 112, 
121) the infection is attributed to the cows drinking or wading in sewage-pol- 
luted water. In three instances (Nos. 118, 123, 131) the infection was spread 
in ice cream prepared in infected premises. In 21 instances the dairy em- 
ployees also acted as nurses (Nos. 1, 6, 12, 16, 17, 24, 30, 37, 38, 41, 46, 52, 
65, 68, 82, 110, 111, 115, 126, 127, 133). In 6 instances (Nos. 101, 102, 113, 
117, 132, 134) the patients while suffering from a mild attack of enteric fever, 
or during the first week or ten days of their illness continued at work, and those 
of us who are familiar with the personal habits of the average dairy boy will 
have no difficulty in surmising the manner of direct digital infection. In one 
instance (No. 24) the milk tins were washed with the same dishcloth used 

45276°— Bull. 56—12 4 



50 

among the fever patients. In one instance (No. 87) the disease was attributed 
to an abscess of the udder, in another (No. 92) to a teat eruption, and in No. 
81 to a febrile disorder in the cows. Nos. 85, 103, 120, and 127 were creamery 
cases. In No. 96 the milk had been kept in the sick room. 

SCARLET-FEVER EPIDEMICS. 

Mr. Hart collected 15 epidemics of milk scarlatina, and we have tabulated 
59, making a total of 74 epidemics spread through the medium of the milk 
supply, the details of which will be found in Table No. II. 

In 41 instances the disease prevailed either at the milk farm or dairy. In 6 
instances persons connected with the dairy either lodged in or had visited infect- 
ed houses. (See Nos. 8, 9, 10, 11, 15, 40.) In No. 12 the milkman had taken his 
can into an infected house. In 20 instances the infection was attributed to dis- 
ease among the milch cows; in 4 of these (Nos. 17, 18, 19, 35) the puerperal 
condition of the animal is blamed. In 9 instances disease of the udder or teats 
was found. (See Nos. 30, 31, 34, 39, 41, 59, 61, 62, 66.) In one instance (No. 
54) the veterinarian diagnosed a case of bovine tuberculosis. In 6 instances 
there was loss of hair and casting of the skin in the animal. ( See Nos. 17, 18, 
19, 38, 40, 41.) In No. 68 the cattle were found to be suffering more or less from 
febrile disturbance. In 10 instances the infection was doubtless conveyed by 
persons connected with the milk business, while suffering or recovering from an 
attack of the disease (see Nos. 2, 22, 26, 29, 42, 57, 58, 60, 69, 71), and in at least 
8 cases by persons who also acted as nurses. (Nos. 1, 2, 7, 9, 13, 14, 25, 63.) 
In three instances (Nos. 1, 73, 74) the milk had been kept in the cottage close 
to the sick room. In No. 15 the cows were milked into an open tin can which 
was carried across an open yard past an infected house, and in No. 53 the milk- 
man had wiped his cans with white flannel cloths (presumably infected) which 
had been left in his barn by a peddler. Nos. 21 and 44 appear to have been 
instances of mixed infection of scarlet fever and diphtheria. 

DIPHTHERIA EPIDEMICS. 

Mr. Hart collected 7 epidemics of milk diphtheria and we have added 21 more. 
(See Table III.) In 10 of these 28 instances diphtheria existed at the farm or 
dairy, and in 10 instances the disease is attributed directly to the cows having 
garget, chapped and ulcerative affections of the teats and udder, while in No. 13 
the cows were apparently healthy but the calves had diarrhea. (See Nos. 2, 5, 
14, 18, 19, 20, 21, 22, 24, 25.) In No. 23 one of the dairymaids suffered from a 
sore throat of an erysipelatous character, and in No. 27 the patient continued 
to milk while suffering from diphtheria. In No. 28 one of the drivers of the 
dairy wagons was suffering from a sore throat. 



51 



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3. THE MILK SUPPLY OF CITIES IN RELATION TO 
THE EPIDEMIOLOGY OF TYPHOID FEVER. 



(i5i; 



THE MILK SUPPLY OF CITIES IN RELATION TO THE 
EPIDEMIOLOGY OF TYPHOID FEVER. 



By Leslie L. Lumsden, 
Passed Assistant Surgeon, Public Health and Marine-Hospital Service. 



Milk is a favorable culture medium for the typhoid bacillus. 
Therefore, if a small particle of matter containing this organism is 
introduced into milk the organism may undergo rapid multiplication 
and become disseminated throughout the bulk of the milk. The tem- 
perature at which the milk is kept and the number and kind of other 
bacteria present affect the rate at which the multiplication of typhoid 
bacilli takes place, and in some instances, no doubt, the bacilli, after 
gaining access to a body of milk, die out before that milk is drunk. 
In the majority of instances, however, it is probable that the bacilli 
will survive and so endanger all susceptible persons into whose 
alimentary canals such milk is taken. 

Considering the tremendous multiplication which the bacilli can 
undergo within twenty- four hours in milk it is easy to appreciate 
how one bottle or can of infected milk taken into a dairy and there 
mixed with a large volume of milk may be responsible for exposure 
to infection of several thousand persons. 

Dairy products, such as ice cream, buttermilk, butter and cheese, 
etc., made from infected milk may be factors in the spread of typhoid 
fever. 

Ice cream. — It has been proven experimentally that the process of 
freezing does not at once destroy all typhoid bacilli, and outbreaks 
of typhoid fever have been traced quite definitely to infected ice 
cream. 

Butter and cheese. — Butter made from milk experimentally 
infected with typhoid bacilli may retain the bacilli, according to 
Bruck, a as long as twenty-seven days, and according to Washburn & 
for as long as sixty days or more. Although it would seem, under 
ordinary circumstances, that the presence of many vigorous sapro- 

« Bruck, Deut. Med. Woch., vol. 29, 1903, p. 460. 

6 Washburn, Washington Medical Annals, Vol. VII, No. 1, 1908, p. 107. 

(153) 



154 

phytes, the washing out of large numbers of bacteria in the butter- 
milk, and the salting would lessen the chances of typhoid bacilli 
remaining in the butter, yet in view of the experimental evidence this 
dairy product should be kept in mind as a possible factor in the 
spread of typhoid fever infection and its manufacture from pre- 
sumably infected milk prohibited. 

Buttermilk of course would be fully as dangerous as the cream 
from which it was derived. 

Cheese. — The time required for the ripening of cheese makes the 
chances of infection from this dairy product certainly very slight. 

Butter and cheese from a given source are usually so widely dis- 
tributed that should an outbreak of typhoid fever in a large city be 
caused by infection in them it would be very difficult to trace unless 
the outbreak were very pronounced and other possible factors could be 
excluded so that attention would be directed to these dairy products. 

WAYS IN WHICH THE TYPHOID BACILLUS MAY GET INTO MILK. 

At the dairy farm. — The milk supply for the average American 
city is obtained from a large number of dairy farms, and the lia- 
bility of cases of typhoid fever developing every year among per- 
sons living on these farms can be readily appreciated. The city of 
Washington, for example, obtains its milk supply from about 1,000 
dairy farms. Estimating the average number of persons living at 
a dairy farm at about 7, and considering the fact that every year, 
in the United States, about 1 person in every 300 has typhoid fever, 
some 25 cases per year may be expected to occur on the dairy farms 
supplying Washington with milk. 

When cases exist on the dairy farms, there is, in the majority of 
instances, much likelihood of the infection being conveyed from the 
patients to the milk. Frequently the cases are not recognized as 
typhoid until the second or third week of illness, during which period 
no precautions are taken. In many instances there are mild cases 
unattended by a physician and cases following an irregular course, 
which go through the attack without being recognized. Too fre- 
quently when the cases are correctly diagnosed in the comparatively 
early stages of the disease the disinfection of the patient's stools and 
urine and the other precautions necessary to prevent the spread of 
the infection are found to be woefully inefficient. 

When the infection is not destroyed as it leaves the body of the pa- 
tient, there are many ways in which the typhoid bacilli may be carried 
from a patient on a dairy farm to the milk. Thus, those caring for 
the sick or handling the soiled bedding or excreta of the patient may 
convey the infection on their hands or clothing. Persons who have 
recovered from the symptoms of the disease, but are still discharging 
the bacilli in their stools or urine may directly contaminate the milk 



155 

in handling it. Some persons after passing through an attack of 
typhoid fever continue to discharge the bacilli in their stools or urine 
for years. One of these "bacillus carriers" working in milk at a 
dairy farm or dairy may contaminate a can of milk from time to 
time and be the source of infection for a number of cases. 

There have been reported recently several outbreaks of milk-borne 
typhoid fever traced to infection from bacillus carriers. Albert 
reports an outbreak in October, 1907, at Cedar Falls, Iowa, in which 
13 cases occurred in the three families supplied with the suspected 
milk. The man who owned the cow and did the milking had had 
typhoid fever one year previous to the outbreak. He was found to 
have a slight cystitis and typhoid bacilli were demonstrated in the 
urine. No source other than the urine of this man could be discovered 
to account for the infection in the milk. 

Lumsden and Woodward & report an outbreak in September and 
October, 1908, in Washington, D. C, in which 54 cases occurred. The 
cases were among the customers of two different dairymen, both of 
whom, however, received a part of their milk supply from a certain 
farm. All the evidence obtained pointed to this farm as the source 
of the infection in the milk. No history of recent sickness on the 
farm could be ascertained. A search for bacillus carriers among the 
persons on the farm was made and in the specimen of feces obtained 
from one of the milkers — a woman who had had an attack of typhoid 
fever about eighteen years before the time of the outbreak — typhoid 
bacilli were found in large numbers. No source other than the feces 
of this woman could be discovered to account for the infection in the 
milk. 

Scheller, c in the course of an investigation of an unusual preva- 
lence of typhoid fever in a section near Konigsburg, Germany, 
directed his attention to the milk supply. He discovered, among 
those who handled the milk, a woman who was excreting in her 
stools and urine typhoid bacilli. There appeared to be no doubt 
that this woman, who had had an attack of typhoid fever seventeen 
years before, constituted the source of infection for the outbreak. 
There were on the estate 180 persons ; of these, 140 neither consumed 
nor in any way handled the milk and the excreta of all of them 
were found to be free from typhoid bacilli. Of the 40, however, 
who either handled or consumed the milk, 18 were found to be bacillus 
carriers. Only 4 of the 18 had had an a'ttack of typhoid fever and 
these 4 had had the attack some years before. Some of the car- 
riers were excreting the typhoid bacilli in the feces, some in the urine, 

a Hyg. Lab. Bull. No. 41, Jan., 1908, p. 49. 

6 Journ. Am. Med. Assn., March 6, 1909, vol. lii, pp. 749-752. 

c Centblt. f. Bakt, vol. 46, 1908, p. 385. 



156 

and some in both feces and urine. The large number suggested 
that they might be temporary or acute carriers. The woman origi- 
nally discovered to be a carrier was removed from the dairy. The 
milkers were required to wash their hands in a disinfectant solution 
before milking. Those who had typhoid bacilluria were treated with 
urotropin. Within a month after these precautions were taken the 
stools and urine of all the carriers were again examined bacterio- 
logically and all found negative except those of the original woman, 
whose excreta still contained typhoid bacilli in large numbers. 

The Strasbourg School has found, in a number of instances, such 
temporary or acute carriers among healthy persons living in close 
association with typhoid fever cases. 

The possibility of there being chronic or acute bacillus carriers 
among those concerned in handling the milk should be kept in mind 
in the investigation of a suspected milk supply. 

It is possible for persons in the early stage of the disease, and 
even before becoming ill enough to take to bed, to contaminate milk. 
The spread of infection from cases in the early stage has generally 
been considered of infrequent occurrence on the ground that the 
bacilli rarely appear in the urine before the end of the third week 
of illness and that few if any are discharged in the feces during the 
first week or two. On the contrary, H. Conradi, a who has made 
extensive studies on the conveyance of typhoid infection in Germany, 
states that he has reached the conviction that not only is the infection 
transmitted most often during the earliest stages of the disease, before 
its true nature has been recognized, but that it also frequently takes 
place during the incubation period. He bases this opinion on the 
observation that of 89 cases which he attributed to infection by con- 
tact, some 58 per cent of the secondary cases had onset of illness 
within a week after the onset of illness of the primary cases. 

Flies passing from infected excreta to the milk or the milk cans 
may readily convey the infection. 

The excreta of patients thrown into the privy or in the yard or field 
near by may be carried by drainage, seepage, on the feet of persons, 
etc., to the well, spring, or stream from which water is used for wash- 
ing cans, and so be conveyed to the milk. 

In country places there are frequent instances where chickens and 
other fowls have free access to the privy contents and may readily 
carry infection on their fe*et to the well or spring or to the dairy- 
house yard in which milk cans are set. The excreta of patients, care- 
lessly handled, may become dried and carried as dust into exposed 
milk or, more frequently perhaps, into exposed milk vessels. 

°Deut. Med. Woch., Oct. 10, 1907. 



157 

Bottles or cans in some way contaminated at the home or dairy in 
the city and without previous disinfection are again filled with milk 
at the dairy farm may be the means of conveying infection from the 
dairy farm back to the city. 

At the dairy. — Milk after it reaches the city dairy is exposed again 
to the danger of becoming contaminated by persons handling it or 
by flies, dust, etc. 

At the average large city dairy there are a number of employees 
who reside at their own homes. At times some of these persons may 
come directly from the bedside of a case of unrecognized typhoid 
lever in the family to the dairy and, as is the case too frequently, 
without being required to change their clothes or to wash their hands 
in a germicidal solution, engage in handling the milk. 

In some American cities many of the dairies are located in the 
most unhygienic sections, and frequently cases of typhoid fever are 
cared for in houses adjoining the dairy or even in the same building. 
In these instances it is easy to understand how flies may pass from 
the dejecta of a patient to a can or bottle of milk and so be the 
means of conveying the infection. Cans or bottles returned from 
houses in which there are typhoid patients and which have been 
handled by persons caring for the sick and not disinfected before 
being refilled may be the means of disseminating the infection in 
the milk. 

From the water used for washing the bottles or cans, etc., at the 
city dairy, the typhoid bacillus may reach the milk. Considering the 
immense dilution in which the typhoid bacillus must usually exist 
in water taken from a large volume, such as a river or lake, for supply- 
ing a city, it may be that persons are rarely infected directly by the 
organism in the water; but the occasional typhoid bacillus in the 
water, upon being introduced into the milk and there multiplying, 
may infect persons drinking that milk. 

At the grocery. — In the studies of Rosenau, Lumsden, and Kastle 
on the prevalence of typhoid fever in the District of Columbia there 
were found a number of instances in which typhoid patients were 
being cared for in rooms above or to the rear of small grocery 
stores. In these stores milk was sold in small quantities, often as 
little as a cent's worth at a time, so that a quart bottle would be 
divided among several customers. The same hands that nursed the 
patient purveyed the milk. In such instances not only is there a 
likelihood of infection being sent out in the milk directly from the 
store, but these much-handled bottles may do damage when returned 

to the dairy. 

, « 

° Hygienic Laboratory Bulletin No. 35, Report on the Origin and Prevalence 
of Typhoid Fever in the District of Columbia, 1907. 



158 

At the home. — Milk after being delivered to the house may become 
contaminated by the hands of those caring for the sick or by flies, 
etc., and be the medium of conveyance of infection to other members 
of the household. 

DETERMINATION OF AN OUTBREAK OF TYPHOID FEVER DUE TO 

INFECTED MILK. 

In the epidemiological studies of typhoid fever in a city a card 
should be kept for each milk dealer and on this card should be noted 
all cases of typhoid fever in persons who within thirty days previous 
to onset of illness have used milk supplied by that dealer. Thus, as 
soon as an unusual number of cases are reported along the route of 
any dairyman it is apparent on the card and attention may be given 
at once to the dairy and the farms supplying the dairy with milk. 

A number of conditions should be taken into consideration in 
determining what constitutes an unusual number of cases among the 
customers of a given dairyman. Of those conditions to be especially 
considered are the general prevalence of typhoid fever in the com- 
munity, the amount of milk sold, the method of handling the milk 
at the dairy, the number of sources from which the milk comes to 
the dairy, and the way in which milk is served to customers. 

Ten or fifteen cases occurring in the course of ten days among 
the customers of a dairyman who sold 1,000 gallons of milk daily, 
and who at his dairy mixed the milk received from the various 
dairy farms supplying him before delivering it to his customers, 
might not impress an investigator as being an unusual number of 
cases, especially if typhoid fever was generally quite prevalent in 
the community and the cases among the dairyman's customers were 
distributed over a large section of the city. On the other hand, if it 
were learned that at the dairy the milk was bottled directly from 
the individual cans as they came from the different farms, and that 
the 10 or 15 cases had occurred among persons who had been served 
with milk from one farm which supplied the dairy with 10 or 20 
gallons of milk daily, suspicion would fall at once upon the milk. 

In the first case, however, the milk might have been equally at 
fault, the infection having been originally in one can of milk as it 
came from the farm; but as the milk in this can was mixed with a 
large volume of other milk in which, due to temperature, lack of time, 
or other conditions, the infective organisms did not undergo much 
multiplication, and so were distributed in high dilution in the milk, 
even as they may be at times in cases of water infection. 

In order to properly charge to each dairyman the cases having 
used milk supplied by him it is necessary to take into consideration 
not only the source of the milk used regularly by the patient during 



159 

the thirty days previous to onset of illness but also of that used occa- 
sionally. Frequently it will be found that a family receiving its 
regular milk supply from a certain dairy will on occasions, when the 
regular supply is not sufficient for the needs of the day, obtain milk 
from some other dairy, directly or through the grocery store. The 
milk obtained on one of these occasions may be infected and so respon- 
sible for the case. The source of milk used at places other than the 
regular one for taking meals also should be ascertained if possible. 

Cases resulting from infection in the milk are by no means confined 
to persons who use milk as a beverage. The cream or milk used on 
cereals, fruits, or even in coffee may convey the infection. In the 
summer of 1906 in Washington there were six cases in one family of 
eight persons, all of which were attributed quite definitely to infected 
milk. None of the members of this family drank milk, but they all 
used cream on fruits and cereals. Of course the chances of contract- 
ing the infection from milk is greater among persons who use milk 
freely. 

George Newman a sums up the characteristics of milk-borne epi- 
demics as follows: 

(a) There is a special incidence of disease upon the track of the implicated 
milk supply. It is localized to such area. 

(&) Better-class houses and persons generally suffer most. 

(c) Milk drinkers are chiefly affected and they suffer most who are large 
consumers of raw milk. 

(d) Women and children suffer most, and frequently adults suffer propor- 
tionately more than children. 

(e) Incubation periods are shortened. 

(/) There is a sudden onset and rapid decline. 
(g) Multiple cases in one house occur simultaneously. 

(h) Clinically the attacks of the disease are often mild. Contact infectivity 
is reduced and the mortality rate is lower than usual. 

In the different outbreaks due to infected milk it is interesting to 
note how greatly the proportion of persons affected among the users 
of the milk varies. In some outbreaks the proportion is as great as 
25 per cent; for instance, in the epidemic at Palo Alto, Cal., in 1903, 
which was traced to infected milk by Fish, Mosher, and Snow. Of 
the 900 persons who used milk from the infected supply, 232 had 
typhoid fever. In other outbreaks the proportion is as low as 1 or 2 
per cent. Several conditions no doubt influence the proportion of 
persons affected, the most important of which probably is the amount 
of infection in the milk. In the Palo Alto epidemic it was deter- 
mined that the milk became infected through the water used for 
washing the cans and also at times for diluting the milk. This water 
was obtained from a creek which received the drainage from several 
houses in which there were patients with typhoid fever. The water 

a George Newman, Bacteriology and the Public Health, 1904. 



160 

of the creek for two or three weeks must have been quite heavily- 
charged with typhoid bacilli, so that probably the majority of the 
milk cans washed in this water received some of the organisms. 

It is easy to understand how a milk supply thus almost if not quite 
continuously infected for several weeks may cause the infection of a 
large proportion of the persons who use that milk; but when the 
infection is introduced into the milk at irregular intervals for a like 
period, as would be expected when the infection is conveyed on the 
hands or clothing of persons or by flies, etc., a very small proportion 
of the consumers of the milk may become infected. 

The susceptibility of the people supplied with infected milk, of 
course, would affect the proportion. In a community where typhoid 
fever had been prevalent for years, and in which there would be a 
number of persons rendered relatively immune by previous infection, 
we would expect less susceptibility than in a community where the 
disease had never prevailed. 

That it takes susceptibility plus exposure to infection for the 
disease to occur was strongly suggested by an instance in the course 
of a milk outbreak in the District of Columbia in the fall of 1906. In 
a children's home having about 100 inmates 7 children came down 
with typhoid fever within a period of two or three days. The way in 
which the milk was delivered to and served at the institution made it 
practically impossible for the 7 children affected to have drunk milk 
from any one can, or one day's delivery, from which at least 75 per 
cent of the children did not drink. Thus of 75 children almost cer- 
tainly drinking infected milk only 7 had the disease. It is conceiv- 
able that in such an instance the typhoid bacilli in the can or cans of 
infected milk either were very few in number or that they were not 
uniformly distributed through the bulk of the milk, so that only one 
or two of the children drinking from a 5 -gallon can of milk actually 
received any of the bacilli; but it seems much more reasonable to 
conclude that all of the 75 children received some of the bacilli and 
the escape of the majority was due entirely to lack of susceptibility 
at the time the organisms were ingested. 

It seems quite probable that different strains of the typhoid bacillus 
vary markedly in their infectiveness. The writer has become im- 
pressed with this view by observing in the course of his studies of 
typhoid fever in the District of Columbia frequent instances in which 
there are one or more cases of typhoid fever in a household in a most 
unhygienic and crowded neighborhood, many persons having free 
association with the patients, the excreta of the patients being handled 
with the grossest carelessness, flies swarming over the excreta as well 
as over the food for the sick and well, and yet under these apparently 
very favorable conditions for the spread of typhoid- fever infection 



161 

not a single secondary case develops among other persons in the 
household, or even in the neighborhood. In other instances, one or 
more cases are being cared for in a household in good sanitary sur- 
roundings, ordinary care as to cleanliness, disposal of patients' ex- 
creta, personal contact with patients, etc., being exercised, and yet 
two or three or more secondary cases develop among other persons in 
the house or in houses near by. 

Of course in making a comparison of such instances it can not be 
stated how much the results are affected by individual susceptibility 
or by the operation of some as yet unknown factor or factors in the 
conveyance of or in the establishment of susceptibility (perhaps 
specific) to typhoid- fever infection. 

It may be readily understood how strains of the organism of a low 
degree of infectiveness (and of virulence) getting into milk, there 
undergoing tremendous multiplication and so being distributed in 
large doses, may cause outbreaks of typhoid fever. This view of low 
infectiveness and virulence of the organism being offset by large 
dosage is supported by some of the features observed in a number of 
the reported milk-borne outbreaks. For instance, short period of 
incubation, sudden onset and rapid decline of attack, reduced contact 
infectivity and low fatality rate. 

It is theoretically possible, however, that these features are due to 
large dosage alone. Thus, a large number of virulent organisms 
upon being introduced suddenly into relatively highly resistant 
tissues, a pronounced reaction occurs (sudden onset of definite symp- 
toms) with resulting formation of relatively large amount of anti- 
bodies (rapid decline of attack, reduced contact infectivity, etc.). 

The establishment of milk as the causative factor in an outbreak of 
typhoid fever is based on the following points : 

(a) A sudden and marked increase in the number of cases along 
the route of some dairyman, without a corresponding increase in the 
number of cases among persons living in the same sections of the city 
but supplied with milk from other sources. In a town supplied largely 
or entirely by one dairyman a sudden increase in the number of cases 
would not implicate the milk unless other facts pointed to it and 
other factors could be excluded, but in large cities, where the people 
of practically every square are supplied with milk by two or more 
dairymen, an increase in the number of cases distinctly on the route 
of a given dairyman is quite easily determined. This fact alone is 
evidence that the milk is responsible, and if an investigation reveals 
that at a time corresponding to the period in which the group of cases 
along the dairyman's route became infected there was at the dairy or 
45276°— Bull. 56—12 11 



162 

one of the dairy farms a patient with typhoid fever whose discharges 
could readily have reached the milk, the chain of evidence is suffi- 
ciently strong to justify the assumption that the outbreak was due to 
the milk supplied by this dairyman, especially if the cases can not 
positively be proven to have been due to some other factor. 

(b) The demonstration of the typhoid bacillus in the suspected 
milk. When this is done, the chain of evidence is, of course, complete. 
But frequently it can not be done, because in the period of usually 
three or four weeks — covering the incubation period, diagnosis, and 
report of the cases — elapsing between the time of infection of the cases 
and the recognition of the outbreak, the typhoid bacillus has disap- 
peared from the milk. 

If cases of typhoid fever are not discovered to account for the 
infection of an implicated milk supply, it is well to examine bacteri- 
ologically the stools and urine of all persons who handle the milk at 
the farms and the dairy. In this way the source of the infection may 
be found in the discharges of some person who has the disease in an 
ambulant and unrecognized form (temporary bacillus carrier) or of 
some one who has been carrying the infection for months or even 
years (chronic bacillus carrier). 

Besides the large groups of cases of typhoid fever caused by in- 
fected milk, there must be in large cities frequently single cases or 
small groups of cases which are due to infection in the milk and yet 
can not be traced to that source. In a community where factors other 
than milk were operating to cause a rather extensive prevalence of 
typhoid fever, 5 or 6 cases occurring within a few days among the 
customers of a dairyman supplying several hundred families with 
milk would direct some suspicion toward that milk supply, but if 
this small group of cases should not be followed by an unusually 
large number of cases on the route of this dairyman and no typhoid 
cases were found on the dairy farm or at the dairy, these 5 or 6 cases 
would be placed by the investigator among those due to causes unde- 
termined or to causes other than milk. In many such instances, how- 
ever, these groups of cases are doubtless due to infection introduced 
in one of the many possible ways — hands, clothes, flies, water for 
washing cans, etc. — into a part of the dairyman's output of milk for 
perhaps only one day. . 

In cities having milk supplied by a number of dairymen, if several 
of these small groups of cases among customers of different dairy- 
men occur at about the same time, a list of the farms supplying each 
of the suspected dairies should be studied, and if it is found that two 
or more of these dairies receive milk from any one farm, an investiga- 
tion should be made of that farm, and in this way the source of the 
infection for the several groups of cases may be determined. 



163 

MEASURES TO PREVENT THE DISSEMINATION OF THE INFEC- 
TION OF TYPHOID FEVER IN MILK. 

(a) The prevention of the introduction of infection into milk. — 
This at once suggests itself as the proper measure ; but the difficulty 
of carrying it out practically becomes evident when we consider the 
number of farms from which the milk supply of the average Amer- 
ican city is obtained, the liability of cases of typhoid fever occurring 
on these farms, and the numerous ways in which the infection may be 
conveyed from the patient to the milk. New York City's milk sup- 
ply, according to Darlington, is derived from 35,000 farms, and 
shipped from 700 creameries, located in 6 States. It is easy to ap- 
preciate how difficult and expensive it would be to keep up a suffi- 
ciently thorough supervision of the multiple sources of that city's 
milk supply. It is practicable to accomplish much toward the pre- 
vention of the infection getting into the milk after the milk is de- 
livered to the city. The f ollowing requirements are suggested : 

1. Location of the dairies in good surroundings. 

2. The prevention of the handling of the milk by persons who are 
in contact with typhoid fever patients or who themselves are liable 
to be discharging typhoid bacilli in their excreta. It does not 
seem unreasonable to require the owner of a store in which milk is 
sold and in which there is a patient with typhoid fever to either 
remove the patient to a hospital or some other house or to close up 
the business until the danger from that patient is passed. 

3. Exclusion of flies ancf other insects so far as possible, by screen- 
ing, etc. 

4. Sterilization of bottles and cans returned from houses before 
being again filled with milk, or the use of paper bottles which would 
not need to be returned. 

5. The sealing of the bottles or cans of milk so that they may not 
be infected in the course of delivery. 

(b) The destruction of infection in milk. — This at the present time 
seems to be the cheapest and the most practicable method to prevent 
the spread of typhoid infection in the milk supply of cities. In 
exceptional instances when a dairy receives its supply of milk from 
only one or two farms over which a thorough supervision may be 
exercised, efforts to prevent the infection reaching the milk may be 
attempted. But for the general supply of cities officially supervised 
pasteurization of the milk is the best measure. Supplement this with 
an intelligent supervision over the depots and stores where milk is 
sold and milk as a causative factor of typhoid fever in cities would be 
removed. 

In other words, pasteurization appears at the present time to be 
the only practical solution of the milk problem. All objections to 
the proper pasteurization of milk seem to be entirely theoretical or 
such as may be readily overcome. 



164 

Of the theoretical objections, one frequently advanced in written 
or spoken arguments and placarded at model dairy farm exhibits is, 
" Pure milk is better than purified milk." That maj be true ; but 
how can pure milk be obtained in sufficient quantity to supply our 
larger cities and at what cost? 

Milk to be desirably clean must be obtained from especially well- 
equipped dairy farms and handled entirely by highly skilled and 
highly conscientious or closely guarded persons. The cost of install- 
ing such equipment and the employment of such a class of labor 
would have to be met by a decided increase in the price of milk, 
while pasteurization — certainly if done on a large scale — should not 
increase the price of milk more than a small fraction of a cent on 
the quart. 

Another objection to the pasteurization of milk is that the heat 
does not remove the objectionable bacteria, but simply kills them, so 
that the consumer gets the dead bacteria anyhow. That is true; 
but does it not appear safer to ingest these dead bacteria than to 
take into the alimentary canal the same bacteria living, which may 
continue to multiply and generate an increasing amount of products 
harmful to the human organism? No reasonable advocate of pas- 
teurization can hold that grossly dirty milk should be used as a food, 
either pasteurized or unpasteurized, the aim being to get milk as 
pure as practicable and then purify it to a point of safety. Milk 
containing only 10 bacteria to the cubic centimeter would not be safe 
if some of those bacteria were typhoid bacilli. 

Another seemingly entirely theoretical objection to pasteurization 
is that the heat changes the milk in some way so that it induces cer- 
tain diseases, such as scurvy and rickets, or lowers the resistance of 
persons using it so that they are more liable to certain infections, 
particularly intestinal diseases. The vast bulk of reliable evidence 
so far recorded on this subject indicates that this objection is not 
supported by facts, while there is constantly accumulating indis- 
putable evidence that there is much sickness caused by organisms in 
raw milk, which organisms would be destroyed by pasteurization. 

A removable objection to the pasteurization of milk is that the 
heat destroys the lactic acid producing organisms which cause the 
" natural souring " of milk, and leaves organisms which produce 
other kinds of fermentation ("putrefaction") to flourish. Should 
this objection prove, by further study, to be valid, it could be met 
readily by adding to the milk after it is pasteurized some pure cul- 
ture of lactic acid forming organisms. 

It seems that in pasteurization we have a practical, unobjection- 
able, immediately needed remedy, while in the necessary measures 
to obtain a pure milk supply for our larger cities we have but a 
hope for the future. 



4. FREQUENCY OF TUBERCLE BACILLI IN THE 
MARKET MILK OF WASHINGTON, D. C. 



(165) 



THE FREQUENCY OF TUBERCLE BACILLI IN THE MARKET 
MILK OF THE CITY OF WASHINGTON, D. C. 



By John F. Andebson, 

Passed Assistant Surgeon and Assistant Director Hygienic Laboratory, Public 
Health and Marine-Hospital Service, Washington, D. C. 



INTRODUCTION". 

Numerous investigators in recent years have shown the infectious- 
ness of milk containing tubercle bacilli for animals. Whether the 
milk from animals with tuberculosis but with healthy udders con- 
tains tubercle bacilli is not definitely settled. Many prominent scien- 
tists seem to have shown that at times the milk from such animals 
does contain tubercle bacilli virulent for laboratory animals, but in 
the view of recent work there may be some doubt as to whether the 
bacilli really passed through the udder but gained access to the milk 
from contamination with feces containing tubercle bacilli. 

Schroeder and Cotton a have recently shown that cows so slightly 
affected with tuberculosis as only to be discoverable by the tuberculin 
reaction pass virulent bacilli in their feces. Many believe that milk 
from a tuberculous cow with unaffected udder is free from infection 
and becomes infected from the feces of the animal or its environment. 
This observation is of the very greatest importance, and if confirmed 
shows, more than ever, that the greatest care is necessary in guarding 
milk from contamination from the time it is drawn until it is con- 
sumed. 

The milk supply of many of the cities of Europe and England has 
been examined for tubercle bacilli. Most observers have used the 
animal test; they have injected various amounts, either centrifugal- 
ized or not, into guinea pigs or rabbits. The percentage of samples 
showing tubercle bacilli has varied between very wide limits, no 
doubt dependent upon the difference in the number of tuberculous 
cows in the herds supplying milk to the different cities and on dif- 

a Schroeder, C. C. and Cotton, W. E. : Bull, of the Bureau of Animal Industry, 
1907. 

(167) 



168 

ferences in technic. Some observers have found that when a number 
of animals are inoculated with the same samples of milk only one, 
perhaps, will develop tuberculosis. Some centrifugalized the milk 
and gave sediment alone, while others gave sediment and cream. 

I will not enter into the question whether the tubercle bacilli found 
in milk are virulent for man, but give my results solely as to whether 
the market milk of the city of Washington contains tubercle bacilli 
virulent for guinea pigs. For myself I object most strenuously to 
using milk containing tubercle bacilli virulent for laboratory ani- 
mals arid prefer to leave the question as to their pathogenicity for 
man to be discussed by others. 

Before presenting the results obtained by me with the market milk 
of the city of Washington it will be interesting to refer briefly to 
results obtained elsewhere by others. 

REVIEW OE LITERATURE. 

Bang, B. Deut. Zeit. f. Thiermed. XI, 1884, p. 45. 

Injected apparently normal milk from the sound quarter of an 
udder another part of which was diseased, into the belly wall of two 
rabbits, which developed inoculation tuberculosis and died after 2% 
and 3J months, respectively. This was repeated later with two more 
specimens of milk, with the same result. He also demonstrated that 
the milk of tuberculous cows without demonstrable udder lesions, 
could contain tubercle bacilli. 

Stein, G. Experimentelle Beitrage zur Infektion der Milch perlsuchtiger Kuhe. 
Inaug. Dissert., Berlin, 1884. 

Intraperitoneal inoculation of guinea pigs with raw milk of tuber- 
culous cows. Ten negative and four positive results. In two of the 
latter tubercle bacilli were demonstrated, and two negative. Some 
of the cows had tuberculosis of the udder. 

Hirschberger, K. Experimentelle Beitrage zur Infectiositat der Milch tubercu- 
loser Kuhe. Deut. Arch. f. klin. Med., XLIV, 1889, p. 400. 

Twenty specimens of milk from tuberculous cows injected into the 
peritoneum of guinea pigs. None of the animals inoculated died of 
septic peritonitis. Eleven of the specimens proved to contain tubercle 
bacilli. (Other acid-fast organisms, of course, were not differen- 
tiated.) By microscopic examination only one of the specimens of 
milk was shown to contain tubercle bacilli. Tubercle bacilli oc- 
curred not only in milk from tuberculous udders, but also where 
the udders were sound, and where the cow was but slightly affected 
with tuberculosis. 

Gebhardt, F. Experimentelle Untersuchungen ueber den Einfluss der Verdun 
nung auf die Wirksamkeit des tuberkulosen Giftes. Virch. Arch., CIX, 
1890, p. 127. 



169 

First series (2.5 cubic centimeters of milk or dilutions injected into 
guinea pigs intraperitoneally ; milk from a tuberculous udder) : Un- 
diluted milk and 1 to 20, positive result ; 1 to 40 to 1 to 100, negative. 

Second series (2 cubic centimeters fluid injected intraperitoneally) : 
Undiluted milk, positive; 1 to 50 to 1 to 200, negative. 

Third series (1 cubic centimeter subcutaneously) : Undiluted milk 
and 1 to 50, positive; 1 to 100 to 1 to 1,000, negative. 

These results show the effect of dilution of infected milk by unin- 
fected milk, as it will be seen that dilutions of greater than 1 to 50 
failed to produce tuberculosis in the inoculated animals. 

In an examination of market milk from ten different sources in 
Munich, 2 cubic centimeters were injected into the peritoneum of 
guinea pigs with negative results in all cases. 

Ernst, H. C. How far may a cow be tuberculous before her milk becomes 
dangerous as an article of food? Amer. Jour. Med. Sci., XCVIII, 1890, p. 
439. 

1. Microscopic examination of cover-glass preparations made from 
milk of tuberculous cows without udder tuberculosis. Various parts 
of milk and cream examined : 

Specimens examined 114 

Specimens containing tubercle bacilli IT 

Per cent 31.5 

Cows examined 36 

Cows having tubercle bacilli in milk 10 

Per cent 27.7 

2. Inoculation of rabbits (method not stated) with similar milk: 

Rabbits surviving first few days, etc 49 

Rabbits becoming tuberculous 5 

Per cent 10.2 

Cows used 13 

Cows with milk shown tuberculous 3 

Per cent 23 

3. Inoculation of guinea pigs (method not stated) with similar 
milk: 

Guinea pigs after necessary exclusions 54 

Guinea pigs becoming tuberculous 12 

Per cent 22 

Per cent (author says) 28.57 

Cows used 14 

Cows giving tuberculous milk 6 

Per cent 42. 8 



170 

4. Feeding calves with similar milk, 5 out of 12 (41.66 per cent) 
became tuberculous. 

5. Feeding pigs with similar milk, 2 out of 5 (40 per cent) became 
tuberculous. 

McFadyean & Woodhead. On the transmission of tuberculosis, etc. Internat. 
Cong. Hyg. and Demog., 1891, sec. 2, p. 197. 

Inoculations with tuberculous udder juice and milk from tubercu- 
lous udders TO per cent were positive (14 of 19). Inoculations with 
nontuberculous udders and milk from tuberculous cows (udders not 
affected), 16 per cent were positive (2 of 13). 

Bang, B. Experiinentelle Untersuchungen ueber tuberculose Milch. Deut. 
Zeit. f. Thiermed. XVII, 1891, S. 1. 

Examined the milk of 28 cows having advanced tuberculosis, but 
no udder involvement. Rabbits injected, with 1 or 2 cubic centi- 
meters intraperitoneally. The milk of two of these cows was shown 
to contain virulent tubercle bacilli. 

Fiorentini, A. Giornale della R. Soc. d'igiene. 1892, p. 198. (Ref. in Baum- 
gartens Jahresb., 1892, p. 698.) 

Injected the milk of tuberculous cows into the peritoneum of 
guinea pigs, with positive results (tuberculosis) in three cases. In 
two of these there was udder tuberculosis. 

Friis, St. Beitrag zur Beleuchtung der Frage ueber die Ansteckungsgefahr 
der Handelsmilch mit bezug auf die Tuberkulose. Deut. Zeit. f. Thiermed., 
Bd. XIX, 1893, p. 115. 

Samples of mixed milk from 46 establishments in and about Co- 
penhagen were examined. Experiments from May to October. 
Eighteen samples must be excluded from consideration on account of 
the early death of the inoculated animals. Of the remaining 28 speci- 
mens, 4 were found to contain tubercle bacilli (14.3 per cent). One 
of the positive specimens was from a herd of 30 cows, only 1 of which 
was suspected of having tuberculosis, showing the danger of diluted 
tuberculous milk. The other milk in which the tubercle bacilli was 
found was from dairies having one or more tuberculous cows. 

Friis, St. Fortgesetzte Untersuchungen u. s. w. Deut. Zeit. f. Thiermed. Bd. 
XX. 1894, p. 195. 

In a former paper, q. v., the author has considered town milk, 
from Copenhagen. He now investigates country milk, taking the 
specimens at the railroad station upon the arrival of the milk. Ex- 
periments from January to May ; the former examinations were at a 
later time in the year. 



171 

Five cubic centimeters each of 40 specimens were injected intra - 
peritoneally into rabbits. Seven specimens excluded by early death 
of the animals. No tubercle bacilli were demonstrated in any of the 
remaining 33 specimens, although in one instance the findings were 
extremely suspicious. Consequently the country milk is regarded as 
being much freer from tubercular infection than the town milk. 
Also a much smaller percentage of animals died of peritonitis when 
injected with the country milk. 

Schroeder, E. C. Further experimental observations on the presence of tu- 
bercle bacilli in the milk of cows. Bulletin No. 7, B. A. I., Agric. Dept. 
1894, p. 75. 

1. Samples of mixed milk from dairies. Forty cubic centimeters of 
milk centrifuged, 5 cubic centimeters of sediment layer injected into 
the peritoneum of guinea pigs. Other pigs inoculated with 5 cubic 
centimeters of the whole milk. Of 19 specimens, 1 apparently con- 
tained tubercle bacilli as the animal receiving the whole milk died 
of tuberculosis. Its companion getting the centrifuged sediment 
remained normal. 

2. Samples of milk from tuberculous cows diagnosed clinically or 
by tuberculin. Milk of 12 such cows injected into guinea pigs. Only 
1 showed tubercle bacilli. 

3. Repeated injections into the same guinea pig of milk from the 
same tuberculous cow not having udder tuberculosis. Four such 
cows used, from 2 to 7 pigs receiving several injections of the milk 
of the same cow. None of the pigs became tuberculous. 

The author concludes that careful inspection of all dairy herds, 
which has for its object the detection and removal of all advanced 
cases of tuberculosis, and especially of cows with diseased udders, 
would probably exclude the sale of most infected milk. 

Ernst, H. C. Article on The Infectiousness of Milk, Boston, 1895. Pub. by Soc. 
for Promoting Agriculture. 

Modifies the statements of results made in a former article which 
was published before the completion of the experiments. 
A. Milk from cows having tuberculosis, but healthy udders. 

1. Cover-glass examinations. Thirty-six cows examined; tubercle 
bacilli in milk of 12 (33.33 per cent). 

2. Subcutaneous inoculation of guinea pigs. Eighty-eight guinea 
pigs inoculated; 12 became tuberculous. Fifteen cows examined; 
tubercle bacilli in milk or cream of 6 (40 per cent). 

3. Subcutaneous inoculation of rabbits. Ninety rabbits inoculated ; 
6 became tuberculous. Nineteen cows examined; tubercle bacilli in 
milk of 4 (21 per cent). 



172 

4. Feeding rabbits, details not given. Forty-eight rabbits fed; 2 
became tuberculous. Five cows examined; tubercle bacilli in milk 
of 1 (20 per cent). 

5. Feeding pigs. Ten pigs fed ; 5 became tuberculous. 

6. Feeding calves. Twenty-one calves fed; 8 became tuberculous. 

B. Milk at random from Boston supply. 

1. Cover-glass examination ; 1 specimen out of 33 contained tubercle 
bacilli. 

2. Inoculation of rabbits. Three out of 25 rabbits became tuber- 
culous. (From the tables it appears that 3 of 13 specimens contained 
tubercle bacilli, although this is not stated in the text.) 

C. Of 19 calves born of tuberculous cows, and autopsied within six 
days of birth, no evidence of tuberculosis was found. 

Obermuller, Kuno. Ueber Tuberkelbacillenbefunde in der Marktmilcn. Hyg. 
Rundsch., V, 1895, No. 19, p. 877. 

At first injected the milk without centrifuging. Some, at least, of 
the specimens had been freed from the slime layer in the creamery. 
Of 40 guinea pigs inoculated, 3 died of peritoneal tuberculosis. Eight, 
however, had died within a few hours of inoculation. Later he im- 
proved his technic by first centrifuging the milk and then injecting a 
mixture of the cream and sediment layers. By this method 38 per 
cent of all the animals injected became tuberculous. (Although the 
author does not specifically state it, it appears from the tables that of 
the 19 specimens the animals injected with which remained alive long 
enough to determine the presence of tuberculosis, 9 contained tubercle 
bacilli. 

Buege, A. Ueber die Untersucbung der Milcb auf Tuberkelbacillen. Inaug. 
Dissert., Halle, 1896. 

Nine specimens of Halle market milk were injected into IT guinea 
pigs intraperitoneally. Three specimens were excluded on account of 
the early death of the animals. In 2 of the remaining 6 specimens 
tubercle bacilli were demonstrated by the findings in the animals after 
death. He injected 5 cubic centimeters of a mixture of cream and 
sediment from the centrifuged 40 cubic centimeters sample used in 
each case. 

Delepine, S. Jour. Comp. Path, and Tber., vol. 10, pp. 150, 189. 

By microscopic examination found tubercle bacilli in 4 out of some 
40 specimens of unmixed milk. By the inoculation method, 20 to 
25 per cent of these milks were found to be tuberculous. He prefers 
the subcutaneous method of inoculation to the intraperitoneal, as 
being more delicate. 



173 

Hope, W. E. Report of the Medical Officer of Health, Liverpool, 1897, on tuber- 
culosis as affecting the milk supply of the city. 

Two hundred and twenty-eight samples of milk from town dairies 
were examined and 12, or 5.2 per cent, were found to contain tubercle 
bacilli. Sixty-seven samples from country dairies showed 9, or 13.4 
per cent, with tubercle bacilli. The work was done by Boyce, Dele- 
pine, Hamilton, and Woodhead. Animal inoculations, intraperitoneal 
or subcutaneous, of plain milk or of the sediment after eentrifuging. 

Massone, A. Annali d'igiene sperimentale, 1897, p. 239. (Ref. in Hyg. Rundsch., 
VIII, 1897, p. 605.) 

Examined a large series of samples of Genoa market milk for the 
presence of the tubercle bacillus. Centrifuged TO to 80 cubic centi- 
meters of the mixed milk for 15 minutes, and then injected 5 to 6 
cubic centimeters of a mixture of the cream and sediment into the 
peritoneum of guinea pigs. In 9 per cent of the cases tubercle 
bacilli were demonstrated in the milk by these means. 

Ott. Ein weiterer Beitrag zur Milchhygiene. Zeit. f. Fleisch und Milch- 
hygiene, 1897, VIII, p. 69. 

Examined specimens of mixed market milk for the presence of 
tubercle bacilli. By staining specimens of the milk, treated by a 
special process, he demonstrated tubercle bacilli in 5 out of 43 speci- 
mens. — 11.6 per cent. Guinea pigs were then inoculated intraperi- 
toneally with 5 cubic centimeters of a mixture of cream and sediment 
of centrifuged milk, obtained from the dealers who had furnished 
the tuberculous specimens. 



Speci 
men. 



Tubercle bacilli microscopic- 
ally. 

A few 

+ first examination; —second 
5 per field 

Few 

do 



Inoculation result. 



II 
III 



Pig 1 died in 23 days; tuberculous. Tubercle bacilli found. 
Pig 2 killed in 30 days; tuberculous. Tubercle bacilli found. 
Both pigs normal after 5 weeks. 

Pig 1 died in 28 days; tuberculous. Tubercle bacilli found. 
Pig 2 died in 35 days; tuberculous. Tubercle bacilli found. 
Both killed in 6 weeks. First normal; second tuberculous. 



Tubercle bacilli found. 
Pig 1 died in 40 days; 

mentioned. 
Pig 2 killed in 40 days; 

mentioned. 



tuberculous. Tubercle bacilli not 
tuberculous. Tubercle bacilli not 



In another series, 30 specimens of market milk were injected intra- 
peritoneally into 30 guinea pigs, 5 cubic centimeters each. Six ani- 
mals died of intercurrent diseases, only 2, however, too early for the 
development of tuberculosis. 

Four died of tuberculosis, but it was subsequently found that 2 of 
them had received milk from the same dealer. 

To sum up (after making the necessary exclusions), of 27 (author 
says 28) specimens, 3 contained virulent tubercle bacilli, (11.1 per 
cent) (author says 10.7 per cent). 



174 

Delepine, S. Brit. Med. Jour., 1898, vol. 2, p. 918. 

In a popular lecture, gives the following results with milks col- 
lected by health officers of Liverpool, Manchester, and elsewhere : 

(a) Seven specimens unmixed milk from cows showing no evidence of tuber- 
culosis. Tubercle bacilli in none of the specimens. 

(&) Twenty-two specimens unmixed milk from cows showing distinct evi- 
dence of tuberculosis and in 6 cases udder involvement. Tubercle bacilli in 
27.24 per cent. 

(c) Fifty -four specimens mixed town milk. Tubercle bacilli in 5.55 per 
cent. 

(d) One hundred and twenty-five specimens country farm milk. Tubercle 
bacilli in 17.6 per cent. 

The presence of tubercle bacilli was determined by inoculation of 
guinea pigs and their post-mortem examination. 

Petri. Zum Nachweis der Tuberkelbacilli in Butter und Milch. Arb. a. d. 
kais. Ges.-Amt., XIV, 1898, p. 1. 

Milk specimens taken from various places in Berlin. Centrifuged 
in 150 cubic centimeter flasks. Three cubic centimeters each of 
cream, skim milk, and sediment injected into 4 guinea pigs (12 
animals for each specimen). Later, on account of the lack of 
animals, 5 cubic centimeters from each specimen were inoculated into 
each of 4 guinea pigs. 

Sixty- four specimens were examined. Tubercle bacilli were dem- 
onstrated in nine (14 per cent). Tubercle bacilli-like rods, not true 
tubercle bacilli in 4 specimens (6.3 per cent). 

It appears that 200 out of the 478 animals died, mostly of peri- 
tonitis within the first three weeks, thus eliminating 7 specimens 
from consideration, and leaving 57 on which to base a percentage of 
incidence. As 9 of these contained tubercle bacilli, the corrected 
percentage would be 17.5. 

The importance of using a large number of animals for each speci- 
men is shown by the fact that in only 3 of the 9 positive specimens 
did more than 1 animal become tuberculous. In these 3 cases there 
were 2. 

Ascher. Untersuchungungen von Butter und Milch auf Tuberkelbacillen. Zeit. 
f. Hyg., Bd. 32, 1899, S. 329. 

Injected 17 specimens of Koningsberg milk into guinea pigs intra- 
peritoneally. One of the animals became tuberculous. The milk 
was partly centrifuged, and the cream and sediment injected, and 
partly uncentrifuged. No other acid- fast bacilli found. 

The first streams from the milking were used, which may account 
for the lower percentage of infected specimens detected by him than 
by Eabinowitsch, who used the last part of the milking. The com- 



175 

parison of results with these different portions of the milking may 
throw light upon the source of infection r>i the milk, whether from 
feces or from the milk glands. 

Jaeger. Ueber die Moglichkeit tuberkuloser Infektion des Lymph-systems durch 
Milch und Milchproducte. Hyg. Rundsch, 1899, IX, p. 801. 

Examined the milk supplied to a large hospital in Konigsberg. 
The dairy was in good condition and frequently inspected, but the 
cows were not tested with tuberculin. 

Six guinea pigs were injected with the milk intraperitoneally. 
Two died of sepsis, 2 remained normal, and 2 developed tuberculosis. 

One hundred specimens were examined by the coverglass method 
for the tubercle bacillus, which was demonstrated in 7 specimens. 

Kanthack, A. A., and Sladen, E. S. St. B. Influence of the Milk Supply on the 
Spread of Tuberculosis. Lancet, 1899, vol. I, p. 74. 

Examined the milk supply of the various colleges in Cambridge 
for the presence of the tubercle bacillus. Milk from 16 dairies was 
examined, 3 specimens from each. Two guinea pigs were injected 
subcutaneously with each specimen, one from the cream layer and 
the other from the sediment, after centrifuging 10 cubic centimeters 
of the milk for minutes; guinea pigs examined after death 
from disease or killed, the characteristic histological tubercle being 
deemed necessary for the diagnosis of tuberculosis. Of 33 animals 
suspected of being tuberculous 10 were found by microscopical exam- 
ination to be free from the disease, while of 23 having typical histo- 
logical tubercular lesions, 16 showed the presence of the bacillus. 

Eesults: Of 16 daries examined, 9 furnished tubercular milk. Of 
90 guinea pigs inoculated, 23 died from tuberculosis (25.55 per cent). 
It is interesting to note that 13 of these were inoculated with the 
cream layer, while only 10 received the sediment. 

Macfadyen, Allan. Lancet, 1899, vol. II, p. 849. 

In a report of work done at the Jenner Institute for the Hackney 
vestry, it appears that of 100 specimens submitted for examination 23 
had to be excluded from the results because of the premature death 
of the test animals. Of the remaining 77 specimens, 17, or 22 per 
cent, were found to be infected with virulent tubercle bacilli. The 
milk was centrifuged 30 minutes, the cream removed and the milk 
recentrifuged for 30 minutes. The sediment was then used for inocu- 
lating guinea pigs. 

Ostertag. Zeit. f Fleisch- und Milchhygiene, IX, No. 12, 1899, p. 221. 

Examined the milk of some 50 cows which had no clinical evidence 
of tuberculosis, but had reacted to tuberculin. Milk received with 



176 

complete precautions into liter flasks and immediately cooled. The 
cream rose during transportation and was pipetted off, and to it was 
added enough of the milk to make 80 cubic centimeters. This mix- 
ture was then centrifuged, and a mixture of cream, skim milk, and 
sediment injected into guinea pigs. Three or four animals were 
injected with 10 cubic centimeters of each specimen. Each specimen 
was also examined microscopically for the presence of tubercle bacilli 
and the remainder was fed to guinea pigs. 

Tubercle bacilli were not found in any specimen of the milk by 
microscopic examination. No pseudo-tubercle bacilli were found. 
Only 1 animal contracted tuberculosis out of all those injected, rep- 
resenting 1 specimen of 49. The other 3 animals receiving this same 
milk remained healthy and proved normal on section. The authors, 
for reasons which they give, do not regard this one case of tubercular 
infection as being due to the milk. They conclude that there were 
no tubercle bacilli in any of the 49 specimens. Fourteen specimens of 
the mixed milk from this herd were then examined. Only 11 re- 
mained for consideration. One of the injected guinea pigs was found 
tuberculous on being killed after seventy-one days, but the lesions 
were slight and the animal had lost only 20 grams. None of the fed 
animals became tuberculous. 

Rabinowitsch, Lydia, and Kempner, Walter. Zeit. Hyg. XXXI, 1899, p. 137. 

Recalls the results of earlier experiments of Rabinowitsch, in 
which of 25 samples of Berlin milk examined (1897), 7 (28 per cent) 
contained tubercle bacilli. The milk was centrifuged and a mixture 
of the cream and sediment layers injected into the peritoneum of 
guinea pigs. 

The present article deals with an examination of the milk of cows 
reacting to tuberculin. Of 14 such cows, 10, or 71.4 per cent, gave 
milk containing tubercle bacilli. The condition of these cows is here 
detailed : Only 1 had pronounced udder tuberculosis. Another had 
udder tuberculosis demonstrable only histologically. Three cows 
with advanced generalized tuberculosis gave histologically the picture 
of chronic interstitial inflammation of the udder. One cow had low 
grade tuberculosis. One had rales on one examination, but none on 
the next two. Two cows had no symptom of tuberculosis. Another 
showed symptoms of beginning tuberculosis only on the second and 
third examinations. 

This demonstrates that in beginning tuberculosis without discov- 
erable udder disease, and in latent tuberculosis demonstrable only by 
the tuberculin reaction, the tubercle bacilli may be present in the 
milk. They believe that repeated examination would have shown 
tubercle bacilli in the milk of more of these cows. 



177 

Boyce. (Results given by Annett, Lancet, 1900, p. 160.) 

He examined the market milk of Liverpool, England; his results 
are given in the following table: 

Year 1898 : Per cent tuberculous. 

Town milk (75 specimens) 6.6 

Country milk (28 specimens) 17.8 

Year 1899 : 

Town milk (75 specimens) 6.6 

Country milk (63 specimens) 17.4 

The superiority of the town milk is attributed to the inspections 
conducted in town. 

Rabinowitsch, Lydia. Deut. med. Wocb., XXVI, 1900, p. 416. 

Kepeatedly examined the milk of eight Berlin dairies. This milk 
was designed especially for the use of children, was not sterilized, and 
sold for 35 to 60 pfennig per liter. In three of these dairies the cows 
were rigidly tuberculin tested. No tubercle bacilli were ever found 
in this milk. In the other five the cows were subjected to clinical 
oversight by veterinarians, but the tuberculin test was employed only 
now and then upon suspicious animals. In three of these five dairies 
the milk was found to contain tubercle bacilli. The percentage of 
specimens containing tubercle bacilli is not stated. 

Klein. Zur Kenntnis der Verbreitung des Bacillus tuberculosis and pseudo- 
tuberculosis in der Milch sowie der Biologie des Bacillus tuberculosis. 
Centralbl. f. Bakt., 1900, 1. Abt, v. 28, Orig., p. 111. 

Klein examined 100 samples of milk from various country farms in 
the vicinity of London. The samples were placed in conical glasses 
and allowed to sediment. Smears were made from the sediment and 
examined microscopically for tubercle bacilli; guinea pigs were also 
inoculated subcutaneously and intraperitoneally with the sediment. 

Klein's results were : Eight guinea pigs died acutely, 7 showed 
positive tuberculosis, while 42 gave negative results at autopsy. The 
remainder showed staphylococcic and Streptococcic infection. 

Tonzig. Ueber den Antiel, den die Milch an der Verbreitung der Tuberkulose 
nimmt, mit besonderen Untersuchungen ueber die Milch des Paduaner 
Marktes. Arch. f. Hyg., 1900, v. 41. 
This author examined the market milk of Padua. Forty-six 
samples were centrif ugalized ' and the cream and sediment injected 
intraperitoneally into 103 guinea pigs. Nine died within forty-eight 
hours, and none of the remainder when they were killed showed tuber- 
culosis. Tonzig is of the opinion that the danger of infection with 
tubercle bacilli in mixed milk is only slight. 

The tubercle bacillus in milk. Swithinbank & Newman's Bacteriology of Milk, 
1903, p. 213. 
During 1901, 310 samples of milk were taken at the Manchester 
(England) railway station from the milk cans representing 272 

45276°— Bull. 56—12 12 



178 

farms. One hundred and seventy-two of these farms were in Chesh- 
ire, and 18 of them (10.46 per cent) supplied milk found to con- 
tain the tubercle bacillus; 65 were in Derbyshire, and 6 (9.23 per 
cent) supplied milk infected with tubercle bacilli; 25 in Stafford- 
shire, of which 2 (8 per cent) supplied tuberculous milk. 

Thus the milk sent by rail to Manchester from 272 farms, and 
examined by Professor Delepine, was tuberculous from 26 of the 
farms (9.5 per cent). (See Report Health City of Manchester, 1901, 
p. 238.) 

Collingridge. Tubercle bacilli in milk. (Editorial Abstract in Brit. M. J., 
1907, v. 1, p. 763.) 

In 1904, milk samples representing 22 counties in England were 
taken at the railway station and submitted to Doctor Klein, with the 
result that out of 39 samples tubercle bacilli were found in 3; in 
August, 1905, a second series representing 22 counties, and out of 22 
samples 2 contained tubercle bacilli; in 1906, a third series, repre- 
senting 13 counties, yielded 2 positive tuberculous milks out of 25 
samples. 

Proskauer, Seligmann, and Croner. Zeit. Hyg., Bd. 57, 1907, p. 173. 

Made an examination of the milk sent in from Denmark, compar- 
ing it with Berlin milk. The examination was very thorough, in- 
cluding a search for tubercle bacilli by means of animal inoculation. 
Danish milk: Thirteen specimens examined, 5 found to contain 
tubercle bacilli (38.5 per cent). There appears to have been a verbal 
agreement with the contracting parties that the milk furnished should 
have been heated 80° to 84° C. Berlin milk: Of 9 samples, 5 con- 
tained tubercle bacilli (55.5 per cent). However, in five tests of milk 
from dairies controlled by veterinary inspections no specimens were 
found to contain tubercle bacilli. 

Hess, Alfred H. The incidence of tubercle bacilli in New York City milk, 
with a study of its effects on a series of children. J. A. M. Ass., Vol. LII, 
No. 13. (19—.) 

One hundred and twelve specimens of raw milk were examined by 
inoculation into 224 guinea pigs of the cream and sediment obtained 
by centrifugalization, but in 5 instances the animals died within two 
weeks, or were lost in other ways, leaving only 107 samples to be con- 
sidered. 

There were 17 positive results out of the 107, which means that 16 
per cent contained tubercle bacilli. 

THE NUMBER OE TUBERCULAR COWS IN THE DAIRIES SUPPLYING 

WASHINGTON, D. C. 

A letter was addressed to Dr. W. C. Woodward, health officer, 
Washington, D. C, and to the Agricultural Department, requesting 
data as to the number of cows in dairies supplying milk to the city of 



179 



Washington that had responded to the tuberculin test. Dr. J. R. 
Mohler stated October 4, 1907, that of 1,147 recently tested cows sup- 
plying milk to the city of Washington, 214, or 18.6 per cent, responded 
to the tuberculin test. He stated that he did not consider this a fair 
estimate of the extent of tuberculosis in the dairy herds of this vicinity 
as the tests were only being applied to those herds which had recently 
been cleansed by private tests or appear so healthy that their owners 
have no fear of having them tested. 

I am informed by the District health department that 1,059 cows, 
from 51 herds in Virginia, Maryland, and the District of Columbia, 
supplying milk to the city of Washington were tested for their reac- 
tion to tuberculin; of this number 160, or 15.1 per cent of the total 
number of cows tested, responded to the tuberculin test. 

Of course the above figures furnished by the Department of Agri- 
culture and the District health department do not give a fair idea of 
the prevalence of tuberculosis in the herds supplying milk to Wash- 
ington, as only the owners of those herds who had reason to think 
that their cows were free from tuberculosis permitted the test to be 
made. If the test had been applied to all the cows supplying milk 
to the District, I have no doubt that the percentage would be very 
much higher than the above figures would seem to indicate. 

RESULTS OF TUBERCULIN TESTS ELSEWHERE THAN IN HERDS 
SUPPLYING WASHINGTON. 

The following figures by Salmon show the number and percent- 
age of cattle carcasses condemned for tuberculosis during the years 
1901-1905 in the meat-inspection service of the Bureau of Animal 
Industry : 



Year. 


Number ex- 
amined. 


Per cent 

con- 
demned. 


1901 
1902 
1903 
1904 
1905 


5,219,149 
5, 559, 969 
6, 134, 410 
6,350,011 
6,096,597 


0.10 
.14 
.14 

.16 
.18 



This does not show the total number of animals affected with tuber- 
culosis, for in many cases only a part of the carcass was condemned 
and probably many had the disease so slightly that the entire carcass 
was passed as fit for food. 

The following table, also taken from Salmon's article, showing the 
results of the tuberculin test of cattle in some States, is of value as 
showing the wide distribution of bovine tuberculosis. It must be 
remembered that most of the herds tested were suspected herds, 
which may account for the very high percentages found. 

° Salmon, D. E. : Bull. No. 38, Bureau Animal Industry, 1906. 



180 



Results of the tuberculin tests of cattle in various States. 



State. 



Number 
tested. 



Number 
tubercu- 
lous. 



Per cent 
tubercu- 
lous. 



Vermont 

Massachusetts 

Massachusetts, entire herds 

Connecticut 

New York, 1894 

New York, 1897-98 

Pennsylvania 

New Jersey 

Illinois, 1897-98 

Illinois, 1899 

Michigan 

Minnesota 

Iowa 



60,000 
24, 685 

4,093 

6,300 
947 

1,200 
34,000 

2,500 
929 

3,655 



Wisconsin: 

Experiment station tests — 

Suspected herds 

Nonsuspected herds 

State veterinarian's tests- 
Suspected herds 

Tests of local veterinarians under State veterinarian on cattle 
intended for shipment to States requiring tuberculin certificate. . . 



,430 
873 



323 

935 

588 
3,421 



2,390 

12, 443 

1,080 



66 

163 

4,800 



122 



115 

81 



191 

76 



3.9 
50.0 
26.4 
14.2 

6.9 
18.4 
14.1 
21.4 
12.0 
15.3 
13.0 
11.1 
13.8 



35.6 
9. 



32.5 
2.2 



THE CHARACTERISTICS OF RABINOWITSCH'S BUTTER BACILLUS. 

The results of some of the earlier workers are open to criticism in 
view of Rabinowitsch's discovery of an acid- fast bacillus in butter 
morphologically similar to the tubercle bacillus. If guinea pigs are 
inoculated with milk or butter containing the acid-fast butter bacillus 
they may often die and will present lesions to the naked eye very 
similar to those produced by the tubercle bacillus. For that reason I 
give the following description of the cultural characteristics and 
post-mortem appearances caused by this organism taken from 
Annett's article. 

The characteristics of Rabinowitsch's micro-organism are as fol- 
lows : It is immotile, and in form closely resembles the bacillus tuber- 
culosis. The bacilli generally occur singly and are often slightly 
curved; but when growing rapidly in tissue bacilli are often found 
lying parallel. Sometimes they form long unbranched threads and 
sometimes are divided into short pieces. The bacilli are somewhat 
thicker than the tubercle bacillus and often show a club-shaped 
swelling on one side. Spores are not formed, but one portion of the 
bacillus stains often more intensely than the rest. The bacilli stained 
by many methods of staining tubercle bacilli can not be distinguished 

a Annett, H. E. : Tubercle bacilli in milk, butter, and margarine. Report 
Thompson Yates Laboratory, 1898-99, pp. 29-35. 



181 

from the latter; only by the employment of very dilute watery 
solutions of methylene blue could any distinguishing feature be ob- 
served, viz, that bacilli from a culture of bacillus tuberculosis stain 
only at one spot, the rest of the bacillus remaining unstained ; while 
in the case of bacillus pseudo-tuberculosis the whole bacillus stains 
faintly and generally uniformly, seldom showing a more deeply 
stained part. 

Cultural differences, however, occur. On agar, the bacilli taken 
direct from an infected animal produce visible colonies on the second 
or third day. At first the agar surface is covered with a thick, moist, 
creamy layer; in old cultures by a folded membrane often orange or 
copper colored. After repeated passages through animals cultures 
on agar or glycerin-agar show a dry, brittle, crumpled membrane 
resembling that of bacillus tuberculosis. In plate cultures the deep 
colonies are gray in color, round or oval, and uniformly granular. 
On the surface, colonies are better developed, have a uniform granu- 
lar gray center, and a clear, wavy outer zone. The surface of the 
colony is often dry and conical. On butter-agar in fresh cultures the 
colonies are small, white, and dry, later spreading over the whole sur- 
face and becoming yellow or copper colored. On potato a luxuriantly 
growing, moist, gray layer is formed. In gelatin, growth proceeds 
very slowly at ordinary room temperatures, colonies becoming visible 
on the third day. In broth, and especially in glycerin broth, growth 
is rapid, forming in two or three days a folded membrane on the 
surface, the broth remaining clear, the culture closely resembling that 
of bacillus tuberculosis. Broth cultures are distinguishable from 
those of bacillus tuberculosis by their characteristic odor, being un- 
pleasant and ammoniacal; that of bacillus tuberculosis being agree- 
able and resembling the odor of flowers. A small quantity of indol 
is formed in broth cultures, which is not so in bacillus tuberculosis 
cultures. Milk is not coagulated, and on the surface is an abundant 
yellowish-red layer which clings firmly to the glass. On albumin- 
free colorless media a growth appears in two or three days, becoming 
in. ten days a thick, yellow, folded membrane; bacillus tuberculosis in 
the same time on such media forming a thin layer just covering the 
surface and just beginning to fold. The presence of fat in these ba- 
cilli can easily be demonstrated, as in the case of bacillus tuberculosis. 

PATHOGENIC PROPERTIES OF BACILLUS PSEUDO-TUBERCULOSIS. 

The following are the post-mortem appearances observed in a 
guinea pig killed three or four weeks after intraperitoneal injection 
of butter containing the bacillus pseudo-tuberculosis: There is a 
slightly distended abdomen; also peritonitis, with adhesions varying 
in nature from delicate fibrinous bands to firm connective tissue. 



182 

The peritoneum and mesentery are studded with nodules. The 
mesenteric glands are swollen and may contain purulent or caseous 
matter. The liver is covered with nodules and patches which may 
be raised above the liver substance or may penetrate into the liver 
parenchyma. The spleen is sometimes only enlarged; at other times 
thickly studded with nodules. The kidneys show yellowish patches. 
The lungs are covered with small transparent nodules which do not 
penetrate into the lung tissue. The sternal lymphatic glands are 
swollen, but show no caseation. Numerous bacilli can be demon- 
strated in these lesions. Many animals after injection show con- 
siderable signs of illness during the first fourteen days, with diminu- 
tion in weight, and then recover. Pure cultures of this bacillus 
are only pathogenic for guinea pigs (but not always) ; rabbits 
and white mice are immune. After intraperitoneal inoculation of 
guinea pigs some die in from four to eight weeks, with considerable 
emaciation, and show the following post-mortem appearances: At 
the seat of inoculation there is a purulent infiltration containing 
the characteristic bacilli; also peritonitis, varying in intensity from 
a flocculent fibrinous exudation to strong connective tissue adhesions. 
The mesentery is studded with small nodules ; the glands are en- 
larged, but not caseous; there are patches on the liver, and miliary 
nodules throughout an enlarged spleen. The thoracic cavity and or- 
gans are often almost exempt from lesions. Infected animals do not 
react to tuberculin. Histologically the nodules in the liver and 
spleen consist of a collection of lymphoid elements with but very 
few epithelioid and multinuclear cells. The bacilli are found in the 
middle of a young nodule, toward the periphery if caseation has 
commenced. The typical giant cells of tuberculosis do not occur. 
More often — especially after inoculation with butter containing 
the pseudo-tuberculosis bacilli — the nodules appear to consist of a 
central necrosed portion surrounded b}^ a leucocytic infiltrated area. 

COLLECTION OF SAMPLES AND TECHNIC. 

The samples of milk were all collected and brought to the Hygienic 
Laboratory by an inspector of the health department of the District 
of Columbia. Usually a pint bottle, though sometimes a quart, with 
the paper cap untampered with was obtained either from the diary 
or delivery wagon. The bottle was at once placed on ice by the col- 
lector and usually reached the laboratory in about one hour after 
collection. A few samples were obtained from some of the hospitals 
and charitable institutions of the District. The milk and cream were 
well mixed by vigorously shaking the bottle. The sample for plat- 
ing was taken out with a sterile pipette, and then 50 cubic centimeters 
of the mixed milk was put into a large sterile centrifuge flask. To 



183 

the 50 cubic centimeters of milk was added 100 cubic centimeters of 
sterile water. The flask was then put into the centrifuge machine and 
centrifuged for one hour at about 2,000 revolutions per minute. The 
milk was diluted with twice its volume of water with the idea that 
it would decrease the specific gravity of the milk and so permit of 
the easier sedimentation of the tubercle bacilli. Usually only one 
animal was inoculated from each sample, though in some cases two 
animals were used. Guinea pigs, largely those raised in the labora- 
tory, of as uniform weight as obtainable, were inoculated with 5 cubic 
centimeters of the sediment of this centrifugalized mixture of milk 
and water. The inoculation was made subcutaneously in the belly 
wall. For each guinea pig a different syringe was used. All of the 
guinea pigs, usually 8, that being the usual number of daily samples, 
inoculated on the same day were kept in the same cage, those that 
remained healthy being controls on their environment, etc. The 
guinea pigs were examined for enlarged glands after about four weeks, 
and those with enlarged glands were separated from the others so 
as to avoid the danger of infecting others if the glands broke down. 

Many of the animals inoculated died from acute infection with the 
millions of other bacteria in the milk. Autopsies were made on all 
the animals that died, but no attempt was made to determine the 
causal organisms other than the tubercle bacillus. 

Those guinea pigs which did not die in at least two months were 
chloroformed, after having been tested with tuberculin, and careful 
autopsies were made on each animal. Smears, cultures, and sections 
were made from the various organs of the animals that showed any 
change from the normal. The smears were stained with carbol- 
fuchsin and examined for acid-fast bacilli. Cultures were made on 
glycerinized potato and glycerin-agar. In no instance did any of the 
cultures show a quick-growing acid-fast organism resembling in any 
way Rabinowitch's butter bacillus. The sections were stained with 
carbol-fuchsin for tubercle bacilli, and also with hsemalum and eosine 
for histological appearances. The above details were carried out with 
few exceptions in all of the animals that gave a positive result. 

It occurred to me that those animals which had tuberculosis might 
be differentiated from those with other infections by giving all of 
the guinea pigs alive at the end of two months a sufficient dose of 
tuberculin to cause the death of the tuberculous animals in less than 
twenty-four hours. Several preliminary tests on known tubercular 
animals showed that 2 cubic centimeters of crude tuberculin given 
subcutaneously would almost invariably cause the death of such a 
guinea pig in from six to eighteen hours. As high as 7 cubic centi- 
meters of the same tuberculin given to a healthy pig caused only a 
temporary discomfort, passing off in a few hours. A rather hasty 



184 

search of the literature failed to show that this idea of giving an 
amount of tuberculin sufficient to cause the death of a tubercular 
animal as a means of differentiating true tuberculosis from infection 
with other acid- fast organisms had ever been used by previous work- 
ers. The febrile reaction in a sick guinea pig on account of the great 
variation in the temperature of the animal from handling, etc., is too 
variable a factor, and a more definite reaction, such as the death of 
the animal, is necessary. The technic was as follows: All of the 
animals, in lots of about 30, were given early in the morning 2 cubic 
centimeters of the tuberculin subcutaneously ; they were closely 
watched and as soon as an animal appeared sick it was placed aside; 
as soon after death as possible the animal was autopsied; smears, 
cultures, and sections were made. Of all the guinea pigs, about 250, 
that received the tuberculin, no animal that did not have tuberculosis 
died. Two or three that had slight lesions did not die, but became 
sick. It was noted that all of the animals died whose lesions had 
caseated. The reaction, I think, was of distinct service in eliminat- 
ing infections with other acid-fast organisms. The suggestion is 
made that with some modification the procedure may have a distinct 
place as an aid in differentiating true tuberculosis from infections 
with other acid-fast organisms which produce tubercular-like lesions. 

Samples of milk were examined from 104 different dairies; 10 
samples from 7 hospitals and asylums are also included in this num- 
ber, they being charged also to the dairy supplying the milk. 

The following tables show the laboratory number of the dairy, 
where collected, date of collection, whether the guinea pig inoculated 
died or was killed, interval between inoculation and death, and results 
of the autopsy. 

It is interesting to note that where 2 guinea pigs were inoculated 
with the same sample of milk, in two instances both animals showed 
tuberculosis and in two instances only one was positive : 

TABLE No. 1. 



03 




Date of 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 
since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


be bo 

6 


Pres- 
ent. 


Ab- 
sent. 


44 




July 22 
Aug. 5 
Aug. 19 
....do... 


Wagon 


No. 1.. . 
....do.. . 


Died... 
....do. . 

Killed . 

Died... 

Killed . 
....do. . 


20 
2 

72 

4 

101 

86 

27 
63 


No evidence of tubercle. 






132 








?30 


do 


....do... 


Negative 






?31 


do 


do ... 








14 




July 15 
July 3n 

....do... 




No. 2. .. 
....do... 








inn 


Providence Hos- 
pital. 
do 


do 






101 


do 


Died... 
Killed . 








329 




Aug. 30 


do 


....do... 


Negative 







185 



TABLE No. 1— Continued. 



03 

® 

c 

tJO bio 


1 

3 


Date of 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 
since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


6 
5? 


Pres- 
ent. 


Ab- 
sent. 


330 




Aug. 30 


Providence Hos- 


No. 2 . . . 


Killed . 


63 


Negative 












pital. 














281 




Aug. 26 
.do ... 




No. 3... 


....do.. 


61 


do 






282 




do 


....do... 
No. 4. .. 


....do. . 
....do.. 


61 

88 


do 






114 




Aug. 1 


do 


do 






299 




Aug. 27 


do 


....do... 


Died... 


5 








300 




do . 


.. ..do... 


do ... 


Killed . 
Died... 


95 

2 








?, 




July 12 
Aug. 7 
....do... 




No. 5.. . 








Iffi 






....do... 


....do. . 


8 








156 




do 


....do... 


Killed . 


82 


Negative 






61 




July 24 


do 


No. 6.. . 


....do. . 


93 


do 






86 




July 29 
Aug. 22 




....do... 


....do. . 


90 


do 






256 




do 


....do... 


....do. . 


70 


.....do 






143 




Aug. 6 


do 


No. 7... 


....do. . 


84 


do 






17 




July 16 


do 


No. 8... 


....do.. 


100 


do 






122 




Aug. 2 


do 


....do... 


....do.. 


87 


do 






7 




July 12 




No. 9.. . 


....do. . 


104 


do 






48 




July 22 

Aug. 14 
....do... 




....do... 


Died... 
....do. . 


21 
57 


No evidence of tubercle. 
do 






195 


Dairy 


....do... 






196 




do 


....do... 


Killed . 


77 








303 




Aug. 28 


do 


....do... 


....do.. 


65 


do 






163 




Aug. 8 
Aug. 20 


do 


No. 10... 
....do... 


Died... 

....do. . 


81 

57 


do 






239 


No evidence of tubercle. 






51 




July 23 
July 24 
July 25 
July 26 


Wagon 


No. 11.. 


Killed.. 


94 








64 




Dairy 


do... 


...do... 


94 


do 






68 




Wagon 


....do... 


...do... 


92 


do 






78 




Children's Hos- 
pital. 


....do... 


Died... 


3 
















85 




....do... 


do 


....do... 


Killed.. 


92 


Negative 






119 




Aug. 1 


Columbia Hos- 


....do... 


Died... 


1£ 














pital. 














123 




Aug. 2 


do 


....do... 


Killed., 


77 








131 




Aug. 5 
Aug. 19 
July 17 
Aug. 7 


Wagon 


....do... 


Died . . . 


72 








226 




do 


do... 


Killed.. 








27 






No. 12... 


Died 


19 








151 




Dairy 


No. 13... 


Killed.. 


83 








97 




July 30 




No. 14... 


...do... 


88 


do 






105 




July 31 
Aug. 7 
July 29 


Wagon 


No. 15... 


do .. 


89 


do 






146 




do 


....do... 


Died... 
Killed.. 


4 
89 








93 


Dairy 


No. 16... 


Inguinal and retroperi- 
toneal glands caseous; 


+ 


































mediastinal glands 




















enlarged; spleen en- 




















larged and studded 




















with tubercles; liver 




















and lung numerous 




















tubercular foci; sec- 




















tions show histolog- 




















ical tubercles and tu- 




















bercle bacilli. 






41 




July 19 




No. 17... 


...do... 


98 


Negative 







186 

TABLE No. 1— Continued. 



c3 
§ 

3 . 

t>0 bo 


3 


Date or 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 
since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


■gp. 

6 


Pres- 
ent. 


Ab- 
sent. 


57 




July 23 
Aug. 6 
Aug. 20 




No. 18... 


Killed . 


93 








144 






do. .. 


do .. 


83 


do 






237 




Wagon 


....do... 


...do... 


69 


Inguinal and retroper- 
itoneal glands en- 


+ 




































larged and caseous; 




















spleen and liver en- 




















larged and studded 




















with tubercles; lungs 




















contain tubercular 




















foci; sections show 




















histological tubercles 




















and tubercle bacilli. 






22 




July 16 




No. 19... 


Died... 


66 


No evidence of tubercle. 






76 




July 25 
Aug. 13 
Aug. 30 
July 17 




do... 


Killed.. 


92 








191 




do 


.. do. .. 


Died... 
Killed.. 


3 
63 








323 


.. .do 


do... 








25 






No. 20... 


...do... 


100 


do 






70 




July 25 
July 29 
Aug. 12 
Aug. 23 

July 16 




. do . . . 


...do... 


93 


do . 






88 






do... 


Died 


33 








179 






. do . . . 


Killed.. 


68 








274 






do. .. 


...do... 


69 


do 






20 






No. 21... 


....do.. 


100 


do 






1W» 




Aug. 2 
Aug. 21 
Aug. 27 
....do... 


Dairy 


. .do... 


....do.. 


97 


do 






?47 




do 


do... 


Died... 


li 

65 


.do 






W7 






do 


Killed. 


do 






?<W- 




do 

do 


do... 


....do.. 


65 
40 


do 

No evidence of tubercle. 






321 




Aug. 30 


....do... 


Died... 




39 




July 19 


do 


No. 22 . . 


Killed.. 


98 








102 




July 30 


do 


....do... 


....do.. 


88 


do 






188 




Aug. 13 
July 31 


.. ..do 


do . 


Died... 


20 








108 




do 


No. 23 . . 


Killed.. 


89 








21 




July 16 
Aug. 2 
Aug. 9 
Aug. 21 




No. 24 . . 
do 


....do.. 
...do . 


100 

87 


.....do 






m 




do 






166 




Dairy 


....do... 


....do.. 


81 


do 






248 




.....do 


....do... 


Died... 


2 








325 




Aug. 30 
....do... 




do . 


. . do . 


41 








326 




do 


....do... 


....do.. 


2 

89 








107 




July 31 




No. 25 . . 


Killed.. 








?m 




Aug. 22 
Aug. 26 




.do . . 


do . 


70 


do. 






279 




do 


....do... 


....do.. 


66 


do 






169 




Aug. 9 
July 15 


Wagon 


No. 26 . . 


....do.. 


80 


do 






10 




do 


No. 27.. 


Died... 


5 








S? 




July 23 
do 


do. 


. .do 


Killed 


94 








53 




do 

do 


do 


do 


93 
83 


do 






145 




Aug. 7 
Aug. 22 


do .. 


do.. 


do... 






263 




do 


....do... 


....do.. 


83 


do 






28 




July 17 




No. 28.. 


Died... 


4 


do 






73 




July 25 




....do... 


Killed.. 


93 


do 






74 




....do.. 




do 


Died 


35 








153 




Aug. 7 
Aug. 29 




... do... 


Killed.. 


83 








319 




do 


....do... 


....do... 


63 


do 







187 

TABLE No. 1— Continued. 



1 

be bo 

•g'S 
d 


9 


Date of 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 
since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


Pres- 
ent. 


Ab- 
sent. 


3?o 




Aug. 29 
July 19 
July 31 
Aug. 22 
July 18 
Aug. 22 




No. 28.. 


Killed. . 


63 








40 






No. 29.. 


....do.. 


98 


do 






106 






....do... 


..do.. 


89 


do 






?61 






do... 


do. . 


70 


do . 






31 




Wagon 


No. 30.. 


....do.. 


99 


do 






258 




do 


....do... 


....do.. 


70 


do 






98 




July 30 




No. 31 . . 


....do.. 


82 


do 






1? 




July 15 
July 24 
Aug. 12 
July 17 




No. 32.. 
....do... 


....do.. 
Died... 


101 

n 


do 






67 










178 






. . do... 


Killed.. 


83 








29 






No. 33.. 


Died... 


3 








71 




July 25 




....do... 


Killed.. 


93 


Inguinal, axillary and 


+ 


















retroperitoneal 




















glands caseous ; 




















spleen enlarged, stud- 




















ded with tubercles; 




















liver and lung con- 




















tained many tuber- 




















cles; sections show 




















histological tubercles 




















and tubercle bacilli. 






T> 




...do... 




....do... 


....do.. 


93 


Negative 






171 




Aug. 9 


Dairy 


....do... 


Died... 


24 


No evidence of tubercle. 






?3? 




Aug. 19 
....do... 


do 


....do... 


....do.. 


4 








?33 




do 


....do... 


....do.. 


2 

88 








111 




Aug. 1 
Aug. 15 
Aug. 29 
Aug. 2 
Aug. 20 


Wagon 


No. 34... 


Killed 








?11 




Dairy 


do ... 


do.. 


76 


do... 


i 




811 






do. .. 


do 


63 


...do 






1?1 




. .do 


No. 35... 


.. do . 


87 


.do 






238 




do 


....do... 


....do.. 


70 


do 






260 




Aug. 22 


do 


No. 36.. 


....do.. 


70 


do 






?16 




Aug. 16 


Dairy 


No. 37 . . 


....do.. 


76 


do 






113 




Aug. 1 
Aug 6 
Aug. 19 
Aug. 27 
July 15 


Wagon 


No. 38 . . 


....do.. 


88 


do 






14? 




do 


....do. 


....do.. 


84 
14 
65 


do.... 






??9 


do 


do. .. 


Died . . . 
Killed.. 








296 


do 


....do... 








15 




do 


No. 39 . . 


....do.. 


101 


do 






94 




July 29 
Aug. 19 
....do... 


Dairy 


....do... 


Died... 


5 








??3 




Wagon 


....do... 


Killed.. 


73 








??4 




. .do 


do... 


Died . . . 
Killed . 


11 
61 








283 




Aug. 26 
do. 


Dairy 


....do... 








284 




do 

do 


do... 


....do.. 


61 

84 


do 

do 






138 




Aug. 6 


No. 40.. 


....do.. 




315 




Aug. 29 


do 




....do.. 


63 


do 






3? 




July 18 
July 24 
July 26 
Aug. 12 




No. 41 . . 
do. .. 


....do.. 
do 


99 
93 


do 






66 




. .do. 






79 






.do . 


. do 


92 


.do 






174 




do 


....do... 


Died... 


1£ 








?34 




Aug. 20 


.....do 


do. 


Killed 


71 








235 




...do... 


do 


do.. . 


do 


71 
76 


do 

do 






207 




Aug. 15 


Dairy 


No. 42 . . 


....do.. 




24 




July 17 




No. 43 . . 


....do.. 


100 


do 







1.88 

TABLE No. 1— Continued. 



c3 
<D 


4^ 


Date of 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 
since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


bCbc 

6 


Pres- 
ent. 


Ab- 
sent. 


128 




Aug. 5 


Dairy 


No. 4, . . 


Killed . 


84 








295 




Aug. 27 


Wagon 


....do... 


....do 


65 


do 






23 




July 17 


do 


No. 44 . . 


....do.. 


100 


do 






177 




Aug. 12 
Aug. 21 


do 


....do. 


Died . . . 
Killed . 


70 
71 


do 






244 


do 


....do... 


do 






245 




....do... 


Georgetown 
Hospital. 


do . 


do 


69 


do 
























?A(\ 




do. .. 


do 


. do 


do 


69 
62 


. .do 






m 




Aug. 30 
July 12 
July 26 
Aug. 12 


....do... 


. .do 


do 






6 






No. 45 . . 
....do... 


....do.. 
Died... 
. .do 


104 
11 

If 

42 


do 






83 




do 






172 




....do. . 


do 






173 




....do. .. 


do 


....do... 


Killed . 


Inguinal glands caseous ; 


-~ 


















axillary and medias- 




















tinal glands enlarged; 




















spleen enlarged and 




















studded with tuber- 




















cles; few foci in liver; 




















sections show histo- 














• 






logical tubercles and 
tubercle bacilli. 






26,5 




Aug. 23 
....do... 


do 

do 


....do... 
..do 


Died... 
do 


4 
62 








266 


Inguinal, axillary and 
retroperitoneal 






































glands enlarged and 




















caseous; spleen and 




















liver enlarged and 




















studded with tuber- 




















cles; lungs contain 




















many tubercle foci; 




















sections show histo- 




















logical tubercles and 




















tubercle bacilli. 






267 




....do... 


do 


...do .. 


Killed 


68 


Inguinal, retroperito- 
neal and mediastinal 


+ 




























\ 






glands enlarged and 




















caseous; liver and 




















spleen enlarged and 




















studded with tuber- 




















cles; sections show 




















histological tubercles 




















and tubercle bacilli. 






159 




Aug. 9 




No. 46 . 


do 


82 


Inguinal glands en- 
larged; spleen greatly 


+ 


































enlarged, contains nu- 




















merous tubercles; few 




















tubercles in liver; sec- 




















tions show histolog- 




















ical tubercles. 






268 




Aug. 23 


do 




....do.. 


69 


Negative 






75 




July 25 
Aug. 27 




No. 47 . . 
....do... 


Died... 
Killed . 


17 
65 


No evidence of tubercle. 
Negative 






291 


Wagon 







189 

TABLE No. 1— Continued. 



1 


bp 

'5 


Date of 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 
since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


Ml bC 

d 
8 


Pres- 
ent. 


Ab- 
sent. 


?m 




Aug. 27 
Aug. 2 




No. 47 . . 


Killed . 


65 








120 




do 


No. 48 . . 


....do.. 


87 


do 






4 




July 12 
Aug. 16 
Aug. 28 
July 16 




No. 49... 
....do... 


....do... 
....do... 


104 
75 


do 






??? 




do 






307 






. do.... 


...do... 


64 


do 






18 




do 


No. 50... 


....do... 


96 


do 






236 




Aug. 20 


do 


....do.... 


....do... 


71 


do 






168 




Aug. 9 


do 


No. 51... 


....do... 


81 


do 






324 




Aug. 30 


do 


....do.... 


....do... 


62 


do 






77 




July 25 
Aug. 12 


do 


No. 52.. 


Died. 


3 








180 




do 


....do.... 


....do... 


3 








181 




Aug.. 12 
July 22 


do 


do.... 


Killed.. 


71 








43 






..No. 53.. 


Died... 


22 


No evidence of tubercle. 






65 




July 23 




....do.... 


Killed.. 


93 


Negative 






89 




July 29 
Aug. 7 
Aug. 12 




do. . 


do... 


90 


do... 






159 






do. . 


do... 


83 


...do... 






18? 




Garfield Hospi- 
tal. 


No. 54. 


do... 


83 


.do 






















183 




....do.... 
Aug. 13 


do 

do 


....do.... 
....do.... 


....do... 
....do... 


83 

78 


do 






192 


do 




46 




July 22 




No. 55... 


Died... 


4 








149 




Aug. 7 
....do.... 




do... 


....do... 


1* 
83 








1.50 




do 


do 


Killed.. 








270 




Aug. 23 


do 


....do... 


....do... 


69 


do 






271 




do... 


do 


....do... 


....do... 


69 


Anterior mediastinal 
glands enlarged and 
caseous; liver studded 
with numerous tuber- 
cles ; tubercle bacilli 
found in smears. 


+ 




80 




July 26 
Aug. 23 
Aug. 9 




No. 56. . 


do. . 


92 








?,73 






do 


do . 


69 


..do 






165 




Wagon 


No. 57... 


....do... 


81 


do 






54 




July 23 


do 


No. 58 . . 


....do.. 


94 


do 






251 




Aug. 21 


do 


....do... 


....do.. 


71 


do 






as 




July 24 
Aug. 15 
July 29 
Aug. 27 




No. 59 


do 


93 


. ..do 






?m 






No. 60 


do 


76 


do 






90 




Wagon 


No. 61.. 


....do.. 


89 


do 






293 




do 


....do... 


....do.. 


65 


do 






294 




do ... 


do 


do . 


do 


65 

77 


...do 






197 




Aug. 14 


dO : 


No. 62 . . 


....do.. 


Spleen enlarged and 


+ 


















studded with tuber- 
cles; liver contains 
tubercular foci; spleen 
sections show histo- 
logical tubercles and 
tubercle bacilli. 






164 




Aug. 9 


do.. 


No. 63 . . 


. ..do .. 


81 








167 




do 


do 


No 64 


do 


81 


do 






243 




Aug. 20 


do 


....do... 


....do.. 


71 


do 






99 




July 30 


do 


No. 65 . . 


Died . . . 


1| 








313 




Aug. 29 


do 


....do... 


Killed.. 


63 


Negative 







190 



TABLE No. 1— Continued. 



03 

'3 . 


s 


Date of 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 
since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


W)bO 

•g'S 
d 


Pres- 
ent. 


Ab- 
sent. 


314 




Aug. 29 
Aug. 6 
Aug. 28 




No. 65 . . 


Died . . . 


15 








139 






No. 66 . . 


Killed.. 


84 








306 




do 


....do... 


....do.. 


64 


do 






272 




Aug. 23 


Wagon 


No. 67 . . 


....do.. 


66 


do 






36 




July 18 
July 29 
do ... 




No. 68 . . 


Died . . . 


3 








91 






...do... 


Killed.. 


89 








92 




do 

do 


....do... 


....do.. 


89 
66 


do 

do 






?85 




Aug. 26 
do ... 


do . 


do. . 




?,86 




do 

do 


....do... 


....do.. 


66 
81 


do 






170 




Aug. 9 


No. 69 . . 


....do.. 


....do 






309 




Aug. 28 
Aug. 29 


.do 


do. . 


do . . 


64 


do 






317 




do 


....do... 


Died... 


1 








328 




Aug. 30 
July 15 
Aug. 8 


do 


...do ... 


Killed . 


63 


Negative 






11 






No. 70 .. 


do .. 


101 


do 






160 




do 


....do... 


....do.. 


82 


do 






257 




Aug. 22 


do 


....do... 


Died... 


1 








199 




Aug. 14 
Aug. 6 
Aug. 16 
July 16 
July 23 




No. 71 . . 


Killed . 


76 


Negative 






137 






No. 72 . 


. .do.. 


84 


do 






7115 




do. 


do 


do .. 


75 


do 






16 




do 


No. 73 


Died 


1£ 

3 


do 






55 




do 


....do... 


....do.. 


do 






56 




....do... 


do 


....do... 


Killed . 


95 


Inguinal and retroperi- 


+ 


















toneal glands caseous; 




















spleen enlarged, stud- 




















ded with tubercles; 




















liver and lung con- 




















tained many tuber- 




















cles; sections show 




















histological tubercles 




















and tubercle bacilli. 






161 




Aug. 8 
do... 


Dairy 


....do... 


....do.. 


82 


Negative 






162 




do 


....do... 


....do.. 


82 
71 

n 

64 


do 






?40 




Aug. 20 
Aug. 27 
....do... 


do 


....do... 


....do.. 


do 






?89 




do ... 


Died 


....do 






?90 




do 


....do... 


....do.. 


Inguinal and mediasti- 
nal glands enlarged 


+ 




































and caseous; liver 




















studded with tu- 




















bercles; sections liver 




















and glands show his- 




















tological tubercle and 




















tubercle bacilli; other 




















organs lost. 






1 




July 12 
Aug. 8 
Aug. 19 
Aug. 5 




No. 74.. 


Killed . 


104 








158 






....do... 


Died . . . 


26 
84 








WIR 




. .do 


...do ... 


.do.. 








133 


Wagon 

do 


No. 75 . . 


Killed . 


Negative 






228 




Aug. 19 


....do... 


....do.. 


72 


do 






87 




July 29 
Aug. 16 
July 15 


do 


No. 76 . . 
.do. 


....do., 
.do.. 


89 
75 


do 






?,?A 




do 






13 






No. 77.. 


....do.. 


101 


do 






218 




Aug. 16 


Wagon 


....do... 


Died . . . 


U 









191 



TABLE No. 1— Continued. 



3 . 

60 bC 


^ 


Date of 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 
since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


o 5 - -a 

o ® 

i 


Pres- 
ent. 


Ab- 
sent. 


202 ! 


Aug. 14 
July 18 
July 25 


Wagon 


No. 78 . . 


Killed . 


77 


Negative ' 




33 






No. 79 . . 
No. 80 . . 


Died... 

Killed . 


84 
93 


No evidence of tubercle. 
Negative 






69 


Wagon 






176 




Aug. 12 
July 12 
July 26 
Aug. 12 
Aug. 15 
do .. 


do 


....do... 


.. do 


78 


do 






s 






No. 81 . . 
....do... 


....do.. 
....do.. 


104 
92 

78 


do 






8? 




do 






175 


Dairy 


....do... 


....do; 


do 






?1? 




Sibley Hospital. 
....do.. 


....do... 


....do 


76 


do 






?13 




do ... 


.. .do 


76 
19 


do 






264 




Aug. 23 
Aug. 29 
July 22 

Aug. 5 
Aug. 13 
....do... 


Dairy 


....do... 


Died... 








31? 




Wagon 


....do... 


Killed . 


63 


Negative 






45 






No. 82 . . 
do . 


Died... 

Killed 


19 

84 








1?9 










184 




Dairy 


....do... 


....do.. 


79 


do 






185 




do 


....do... 


Died... 

Killed . 


20 
71 








241 




Aug. 20 
..do... 


do 


....do... 


Negative 






24? 




do 

do 

do 


do ... 


do . 


71 
64 

63 


do 

do 






310 




Aug. 28 
Aug. 29 
Aug. 30 
July 30 
July 18 
July 31 


....do... 


....do.. 




318 


do 


Died 




327 




do 


....do... 


Killed . 


Negative 






96 






No. 83 . 


. do 


89 


do 






34 






No. 84 


Died 


4 








103 




Orphan asylum. 


....do... 


....do.. 


81 


Inguinal, retroperito- 
neal, and mediastinal 


4- 
































glands caseous; spleen 




















enlarged, studded 




















with tubercles; liver 




















and lungs contain 




















numerous tubercle- 




















foci; sections show 




















histological tubercles 




















and tubercle bacilli. 






104 




do ... 


do. 


.do 


Killed 


89 


Inguinal and retroperi- 
toneal glands enlarg- 


4- 




































ed and caseous; spleen 




















and liver enlarged 




















and studded with tu- 




















bercles; sections show 




















histological tubercles 




















and tubercle bacilli. 






130 




Aug. 5 
Aug. 7 


Wagon 

do 


.. .do 


...do . 


83 


do 


+ 




147 




....do... 


....do.. 


83 


Negative 






186 




Aug. 13 

....do... 


Dairy 


....do.. 


Died... 


2 








187 




do 


do 


Killed . 


79 


Negative 






275 




Aug. 26 


do 


....do... 


....do.. 


66 


Inguinal and mediasti- 


+ 


















nal glands enlarged 




















and caseous; spleen 


1 
















and liver enlarged 




















and studded with tu- 




















bercles; many tuber- 




















cle bacilli in smears. 







192 

TABLE No. 1— Continued. 



§ 

3 . 
bo be 


53 


Date of 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 
since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


o ►* 
d 


Pres- 
ent. 


Ab- 
sent. 


276 




Aug. 26 
Aug. 14 




No. 84 . . 


Died... 


16 








198 




do 


No. 85 . . 


Killed.. 


77 


Negative 






304 




Aug. 28 
Aug. 6 


do 


. .do... 


do. . 


64 


.. ..do... 






140 




do 


No. 86 . . 


....do.. 


84 


Inguinal glands en- 


+ 


















larged and caseous; 




















retroperitoneal and 




















mediastinal glands 




















enlarged; spleen and 




















liver enlarged and 




















studded with numer- 




















ous tubercles; tuber- 




















cle in liver; sections 




















show histological tu- 




















bercles. 






?06 




Aug. 15 
Aug. 28 


do 


....do... 


....do.. 


76 








305 




do 


....do... 


....do.. 


64 


do 






109 




July 31 


do 


No. 87 . . 


....do.. 


79 


do 






280 




Aug. 26 


do 


....do... 


....do.. 


66 


do 






3?,7 




Aug. 19 
Aug. 27 
....do... 




No. 88 . . 


....do.. 


73 


do 






301 




....do 


....do... 


....do.. 


65 


do 






30? 




do 

do 


....do... 


....do.. 


65 
70 


do 

do 






259 




Aug. 22 


No. 89 . . 


....do.. 




38 




July 19 


do 


No. 90 . . 


Died... 


3 








95 




July 30 
Aug. 15 
July 17 
Aug. 5 
....do... 


do 


No. 91.. 


Killed.. 


88 


Negative 






?0q 






....do... 


....do.. 


76 


do 






30 






No. 92 . . 


Died... 


5 








135 




Dairy 


....do... 


Killed.. 


84 


Negative 






136 




do 


....do... 


Died... 
Killed.. 


2 








?54 




Aug. 21 
....do... 


do 


....do... 








255 




do 


....do... 


Died... 
Killed.. 


2 
92 








84 




July 26 

Aug. 6 
Aug. 23 




No. 93 . . 


Negative 






141 




Dairy 


....do... 


....do.. 


84 


do 






269 




do 


....do... 


....do.. 


69 


do 






?03 




Aug. 14 
July 12 
July 19 
July 22 
July 23 
Aug. 5 
Aug. 8 
Aug. 14 
Aug. 16 
July 12 
Aug. 8 
Aug. 15 


Wagon 


No. 94 . . 


....do.. 


77 


do 






H 






No. 95. . . 


....do... 


104 


do 






49 






....do... 


....do. . 


98 


do 






4q 






....do.... 


Died... 


4 








58 






....do.... 


Killed.. 


94 








134 




Wagon 

...do 


....do.... 


....do... 


84 


do 






154 




..do... 


. do. . 


82 


do 






?01 




Dairy 


....do.... 


Died... 


3 








914 




do 


....do.... 


....do... 


1J 








3 






No. 96. . . 


Killed.. 


104 








157 






...do.... 


do. . 


82 


do 






210 




do 


....do.... 


....do... 


76 


do 






19 




July 16 


Wagon.. 


No. 97... 


....do... 


101 


do 






127 




Aug. 2 


do 


....do.... 


;...do... 


80 


do 






35 




July 18 
July 24 
Aug. 13 
Aug. 26 




No. 98. 


..do... 


99 


do 






60 






. do... 


Died 


3 








18Q 






. do .. 


Killed. . 


76 








277 




do 


....do.... 


Died... 


8 









193 



TABLE No. 1— Continued. 



3 




Date of 
inocu- 
lation. 


Source. 


Dairy. 


Result. 


Days 

since 
in- 
ocu- 
lated. 


Autopsy. 


Tubercle 
bacilli. 


be bo 
d 


Pres- 
ent. 


Ab- 
sent. 


278 




Aug. 26 
Aug. 2 




No. 98 . . 


Killed.. 


66 








126 




do 


No. 99... 


....do... 


87 


do 






IPO 




Aug. 13 
Aug. 21 
....do.... 


do 


do... 


Died .. 


4 








249 




do 


. do... 


. do... 


2 








250 


do 


....do.... 


....do- 


5 








47 


July 22 
Aug. 7 
Aug. 16 




No. 100. 


do . 


18 








148 




....do.... 


Killed.. 


83 


Negative 






219 


do 


....do.... 


....do... 


75 


do 






220 




....do.... 


do 


....do.... 


....do... 


75 


do 






112 




Aug. 1 
July 17 
July 24 
Aug. 1 
Aug. 13 


Wagon 


No. 101.. 


....do... 


87 


do 






26 1 




No. 102.. 
....do... 


....do.. 
....do.. 


100 
95 


do 






62 i 




do 






117 ! 




. .do . . 


Died... 


9 








193 1 


do 


....do... 


....do.. 


25 


No evidence of tubercle . 






194 


.. .do 


do. 


do 


Killed.. 


75 








59 




July 23 




No. 103.. 


....do.. 


94 


Inguinal and retroperi- 
toneal glands caseous; 


+ 




































spleen enlarged and 




















studded with tuber- 




















cles; liver showed nu- 




















merous tubercular 




















foci; sections show 




















histological tubercles 




















and tubercle bacilli. 






?00 




Aug. 14 
Aug. 28 




. do . . . 


do .. 


77 








308 




do 


....do... 


....do.. 


64 


do 






316- 




Aug. 29 


do 


....do... 


Died... 


2 








P 




July 15 




No. 104.. 


....do.. 


3 








37 




July 19 
Aug. 21 




. .do .. 


do . 








?5? 




Wagon 


....do... 


Killed.. 


71 








?53 




. . . . do . . . 


do 

do 

do 


....do... 


....do.. 


71 
67 
19 


do 






287 




Aug. 26 
....do... 


....do... 


....do.. 


do 






?88 


....do... 


Died... 

















The following table gives a summary of the above protocols. It 
shows the laboratory number of the dairy, number of samples from 
each dairy, number of samples lost by the animal dying in less than 
three weeks of other infections, number samples remaining for observa- 
tion, and total number of samples for each dairy positive for 
tuberculosis. 

The same details are shown in Table 3 for the milk collected from 
the charitable institutions. 



45276°— Bull. 56—12- 



-13 



194 



TABLE NO. 2. 



Dairy. 



Number 



10.. 
11.. 
12.. 
13.. 
14.. 
15.. 
16.. 
17.. 
18.. 
19.. 
20.. 
21.. 
22.. 
23.. 
24.. 
25.. 
26.. 
27.. 
28.. 
29.. 
30. 
31. 
32. 
33. 
34. 
35. 
36. 

37. 

38. 

39. 

40. 

41. 

42. 

43. 

44. 

45. 

46. 

47. 

48. 

49. 

50. 

51. 

52. 

53. 

54. 



Number 
samples 
lost by- 
acute death 
of guinea 
Pig- 

2 



1 



1 

2 
1 



1 





1 



1 
1 



1 




1 

1 





1 

2 





1 
1 



1 





1 



1 






1 
1 





Number 

samples 

remaining. 



Number 
samples 
positive 
for tuber- 
culosis. 



195 



TABLE NO. 2— Continued. 



Dairy. 



Number 
of samples 



Number 
samples 
lost by 
acute death 
of guinea 
Pig- 



Number 

samples 

remaining. 



Number 
samples 
positive 
for tuber- 
culosis. 



100. 
101. 
102. 
103. 
104. 



Total... 
Per cent . 



272 



223 
82 



196 



TABLE NO. 3. 



Hospital. 


Number 
of samples. 


Number 
samples 
lost by 
acute 
death of 
guinea pig. 


Number 

samples 

remaining. 


Number 
samples 
positive 
for tuber- 
culosis. 


Providence 


2 
1 
1 
2 
1 
1 
2 








1 


2 
1 

1 
2 
1 
1 
1 





Children's 





Georgetown 





Garfield 





Sibley 







a\ 


Columbia . : 









Total 


10 


1 

10 


9 
90 


1 




11.1 









a Both pigs from sample positive. 



RESUME. 



It will be seen from the above that of 272 samples of milk 49, or 18 
per cent of the samples, were lost by the animals dying in less than 
three weeks and before sufficient time had elapsed for them to develop 
tuberculosis. Attention is invited to the fact that the milk from some 
of the dairies killed acutely a high percentage of all of the animals to 
which it was given. 

Of the 272 samples 223, or 82 per cent, remained for study. 

Of the 223 that remained 15, or 6.72 per cent, contained sufficient 
tubercle bacilli to cause typical tuberculosis in the inoculated animals. 

Of the samples of milk from 104 dairies, 2 were lost by acute death 
of the animals, leaving 102 ; the milk from 11 of these 102 dairies con- 
tained tubercle bacilli. This gives a percentage of 10.7 of the dairies 
examined showing tubercle bacilli in the milk supplied to their 
customers. 

Ten samples of milk were obtained from 7 charitable institutions 
of the District ; of these 10 samples, 1 was lost by the acute death of 
the animal, leaving 9 samples from 6 institutions for study. The 
sample from 1 institution caused tuberculosis in both guinea pigs in 
which it was inoculated. 

These results showing that approximately 11 per cent of the dairies 
whose milk was examined contained tubercle bacilli virulent for 
guinea pigs do not, however, give a fair idea of the frequency of the 
presence of tubercle bacilli in the market milk of the city of Wash- 
ington. Attention has already been called to the fact that when two 
animals were inoculated with the same sample both did not always 
develop tuberculosis; this would indicate that the bacilli are so few 
in the amount inoculated that one of the animals by being a little 



197 

more resistant was able to overcome the infection. The amount in- 
oculated, less than 2 cubic centimeters of milk, is a very small portion 
of a pint bottle. The creamy layer was not inoculated and other 
workers have shown that tubercle bacilli are more frequent in this 
than in the bottom milk ; it is very probable that if more animals had 
been inoculated with the same sample and both cream and sediment 
used the percentage of positive results would have been very much 
higher. The results, however, as they were found are sufficiently 
high to emphasize the great necessity for the enactment and rigorous 
enforcement of a law requiring that all cows supplying milk to the 
District be tuberculin tested and free of tuberculosis. This test, which 
is now universally recognized as a means of determining whether an 
animal has tuberculosis, should be made by a competent veterinarian 
and those animals that respond should be disposed of in some way so 
that their milk may no longer be a source of danger to the community. 



5. THE RELATION OF GOAT'S MILK TO THE SPREAD OF 

MALTA FEVER. 



(199) 



THE RELATION OP GOATS MILK TO THE SPREAD OP 
MALTA PEVER. 



By John F. Anderson. 

Passed Assistant Surgeon and Assistant Director Hygienic Laboratory, Public 
Health and Marine-Hospital Service. 



Recently it has been shown that Malta fever is conveyed by means 
of the milk of goats infected with the specific organism of the dis- 
ease. While the disease may undoubted] y be spread by other means, 
the use of infected goat's milk in Malta is by far the most important 
factor. 

Malta fever is a specific febrile infection caused by the Micrococcus 
melitensis discovered by Bruce in 1887. The fever is of an irregular, 
recurring or undulating type; in a typical case it lasts for several 
weeks, followed by a period of a few days or weeks of a relative 
apyrexia, which is again followed by other febrile periods. 

Clinically, Malta fever is usually characterized by profuse perspi- 
ration, constipation, frequent relapses, often accompanied by pains of 
a rheumatic or neuralgic character, sometimes swelling of joints or 
orchitis. The disease is characterized by low mortality and indefinite 
duration. 

Malta fever smolders endemically on the island of Malta, at 
Gibraltar, and other places on the Mediterranean basin. At times 
the number of cases at one place constitutes an epidemic. Bruce 
believes that one attack confers a definite immunity against subse- 
quent attacks. Strangers particularly, visiting in the endemic focus, 
are liable to infection. On account of the almost invariable tend- 
ency to undulations of pyrexial intensity Malta fever is often called 
" undulating fever," a name proposed by Hughes. The disease is 
also known as Gibraltar fever, Mediterranean fever, rock fever, etc., 
depending upon the locality. 

The following is a list of places from which Malta fever has been 
reported : 

(201) 



202 

Spain — Gibraltar ; Islands of the Mediterranean — Balearic Islands, 
Corsica, Sardinia, Sicily, Malta, Gozo, Cyprus, Crete; Italy — Rome, 
Naples, Caserta, Benevento, Campobosso, Aricca, Terano, Fermo, 
Padua, Cittanova, etc.; Greece — Athens, Cephalonia; Turkey — Con- 
stantinople, Smyrna; Palestine — Jerusalem; Africa — Tunis, Algiers, 
Alexandria, Suakin, Massowah, Zanzibar, Kimberley ( ? ) , Aden ; 
India — Calcutta, Mian-Mir, Nowshera, Secunderabad, Simla, Delhi, 
Lucknow, Agra, Allahabad, Choabattia, Subatha, Assam, Swat Val- 
ley; China — Hongkong; Philippine Islands; Fiji Islands; North 
America — Mississippi Valley ( ? ) ; West Indies ( ? ) — Cuba ( ? ) , Porto 
Rico ( ? ) ; South America — Venezuela, Brazil, Montevideo. 

Malta fever is a general infection not unlike other specific bacte- 
remias, such as typhoid fever. The Micrococcus melitensis is found 
especially in the spleen and also in the blood. The inoculation of 
pure cultures of this organism into monkeys produces a prolonged 
febrile disease similar to Malta fever. There have been several in- 
stances of the inoculation of pure cultures into man, both intention- 
ally and accidentally, which were followed by the characteristic 
symptoms of the fever after an incubation period of from five to 
fifteen days. Little doubt, therefore, remains that the organism is 
the true cause of the disease. 

From the standpoint of prophylaxis it is of the first importance 
to determine the channel of infection by which the micrococcus enters 
the body. In the cases before mentioned in which the disease was 
produced by inoculating pure cultures of the Micrococcus melitensis 
into man, in one instance the culture was accidentally introduced into 
the conjunctival sac; in the others, by subcutaneous inoculation. One 
case which arose in England is supposed to have been conveyed from 
son to father by using a clinical thermometer in the mouth imme- 
diately after its use by the patient. From experimental evidence, 
therefore, it would appear that the infection of Malta fever may be 
taken in through wounds, the mucous membranes, or by food and 
drink introduced into the mouth. There is no evidence that the 
disease is directly contagious from the sick to the well. 

Malta fever occurs especially in the officers and men of the British 
army and navy stationed at Malta and Gibraltar. All authorities 
recognize the influence of unfavorable hygienic conditions as an etio- 
logical factor of the greatest importance in prophylaxis. Sex has 
no predisposing influence and every age is prone to attacks, but it 
occurs mostly between the ages of 6 and 30 years. 

In Malta the greatest incidence of the disease is in the hot, dry 
month of July. Chilling of the surface, bodily and mental depres- 
sion, etc., are quoted as incidental causes. 

The morbid process is that of a general infection and is seen espe- 
cially in the condition of the spleen, which is enlarged, soft, even 



203 

diffluent. The blood gives the usual picture of secondary anemia. 
The lymphoid elements are but slightly involved; the liver is con- 
gested and the seat of cloudy swelling, and the kidneys are sometimes 
swollen and show glomerular nephritis. 

The period of incubation appears to be from a few days to thirty 
days, usually about fifteen. 

On account of the large number of cases of Malta fever in the 
military and naval population of the island of Malta a commission 
was appointed by the admiralty, the war office, and the civil govern- 
ment of Malta in 1904 for the purpose of studying this disease with 
a view especially of determining the source of infection. This com- 
mission has issued six reports. These reports include a minute study 
of the general sanitary conditions of the island of Malta, the prev- 
alence of the disease there, the various experiments upon the viability 
of the organism under many conditions, and experimental work upon 
susceptible animals. The following data in regard to the relation of 
goat's milk to the spread of Malta fever are largely drawn from these 
reports and, in many instances, are taken verbatim from the reports. 

Until the researches of the commission the means of infection were 
not definitely known. Various theories had been suggested, such as 
the agency of biting insects, the ingestion of infected food and drink, 
the breathing of infected dust, and contacts. 

Epidemiological studies having shown that, while the consumption 
of infected milk may and probably does account for Malta fever 
among the Maltese, yet many cases occur among the military and 
naval population in Malta which can not be attributed to this cause. 
Accordingly a study of mosquitoes as possible carriers of the 
M. melitensis was begun. 

The M. melitensis was recovered four times from a total of 896 
mosquitoes dissected. Deducting from these 896 mosquitoes those 
collected where there was no case of Malta fever or where the cases 
were mostly chronic we would have 4 infected mosquitoes out of 450 
collected in presumably infected places. This result was not unex- 
pected considering the small numbers of the specific organisms found 
in the peripheral blood of Malta fever patients. The mosquitoes 
could not be infected in great numbers or the disease would be much 
more prevalent than it is at present. 

Captain Kennedy a was able experimentally to infect a monkey as 
the result of bites of mosquitoes (Culex pipiens) which had fed on 
patients suffering from Malta fever. An attempt to infect a monkey 
by bites from artificially infected mosquitoes, however, failed. 

a Reports of the commission * * * for the investigation of Mediterranean 
fever * * *. Part 4, 1906, p. 187. 



204 

In the examination of 103 cases of Malta fever for the specific 
organism the minimum quantity of blood from which a positive 
result was obtained was ^-g- cubic centimeters. This fact has an 
important bearing on the question of the possibility of the trans- 
mission of infection by biting insects such as mosquitoes. This is a 
larger amount of blood than any biting insect to be found in Malta 
can contains 

The water supply of Malta is drawn from two sources, the one for 
general use being derived from three springs which are pumped to a 
central reservoir and thence distributed, the second being rain water, 
most of the houses being provided with cisterns for the collection of 
rain water which is largely used for drinking purposes. 

The milk supply of Malta is derived almost entirely from goats, 
though there is a small number of cows on the island and condensed 
milk is used to some extent. The number of milk goats in Malta is 
probably at least 20,000. 

As showing the prevalence of the disease in Malta the following 
figures are of interest: From 1894 to 1903 there was an average of 
32 cases per 10,000 inhabitants per year in the civil population; for 
the same period in the military population the yearly average was 
25.6 per 10,000; from 1901 to 1903, for which years only figures are 
obtainable, the yearly average was 28.55 per 10,000 among the naval 
population. 

In regard to infection other than through goat's milk, Major Hor- 
rocks h concludes that so far as the experiments go it appears that 
infection can not be conveyed from infected to healthy monkeys by 
skin contact alone, all other sources of infection being excluded. In- 
fection can not be conveyed from infected to healthy monkeys by 
ecto-parasites alone. When healthy monkeys living in intimate con- 
tact with diseased monkeys, under mosquito-proof conditions, become 
infected, the infection is due to the absorption of the M. melitensis 
excreted in the urine of the diseased monkeys. 

There is no evidence that Mediterranean fever can be contracted 
by contact with cutaneous surfaces uncont animated by urine. c 

Infection can be acquired by the absorption of urine secreted by 
cases of Mediterranean fever, and this is probably one way in which 
workers in hospitals become infected. 

There is evidence to show that monkeys can be infected by dry dust 
artificially contaminated with cultures of M. melitensis isolated from 

a Reports of the commission * * * for the investigation of Mediterranean 
fever * * *. Part 3, 1905, p. 14. 

6 Reports of the commission * * * for the investigation of Mediterranean 
fever * * *. Part 4, 1906, p. 36. 

c Reports of the commission * . * * for the investigation of Mediterranean 
fever * * *. Part 4, 1906, p. 81. 



205 

the spleen of cases of Mediterranean fever. The path of absorption 
maybe through the nares, throat, respiratory passages, and alimentary 
canal. Dry dust contaminated with the urine of cases of Mediter- 
ranean fever has given rise to infection in goats, but not in mon- 
keys. The experience gained during the work performed in Malta 
during 1904-5 has convinced Horrocks that men are more susceptible 
than monkeys and goats. Shaw's work on ambulatory cases of Med- 
iterranean fever among the Maltese has also shown that opportunities 
for the creation of infected dust are plentiful in Malta. Infected 
dry dust as a cause of Mediterranean fever can not therefore be dis- 
carded. "When infection is acquired in this manner the incubation 
period is probably at least a month. 

Mediterranean fever can be acquired by the absorption of infected 
goat's milk from the alimentary canal. The incubation period in 
this case is also probably long, and may even extend to two months. 

This mode of infection probably plays a great part in the causa- 
tion of Mediterranean fever among the Maltese, who drink raw milk 
drawn at the doors of their houses. 

Horrocks found that the M. melitensis could be recovered from 
khaki cotton, khaki serge, and blankets up to the eightieth day. 
Shaw recovered it from blue serge up to the seventy-eighth day. 

The above results obtained by Horrocks upon the longevity of the 
organism upon khaki, cotton, etc.. are important as showing the pos- 
sible relation of fomites to the transmission of the disease. 

The presence of ambulatory cases of Malta fever must be taken 
into account in the spread and continuance of the disease in Malta. 
These ambulatory cases constantly pass the specific organism in their 
urine and are undoubtedly as much a source of danger to those with 
whom they come in contact as are the bacillus carriers in typhoid 
fever. 

The usual source of milk in Malta is the goat. 6 These animals 
are driven about the streets and milked at the customer's door into his 
own container. The udders, which are abnormally large, often touch 
the ground and are very liable to be soiled. There are so many herds 
that it is often difficult for a householder to tell the source of his milk 
supply. Xo regulations are in force for the effectual control of these 
vendors. 

It was first shown by Zammit c that goats could be infected by feed- 
ing them with the 3f. melitensis. Zammit informed the chairman of 

a Reports of the commission * * * * for the investigation of Mediterranean 
fever * * *. Part 4, 1906, p. 176. 

6 Reports of the commission * * * for the investigation of Mediterranean 
fever * * * Part 2, 1905, p. 11. 

c Reports of the commission * * * for the investigation of Mediterranean 
fever * * *. Part 3, 1905, p. 2. 



206 

the board that he considered goats to be susceptible to Malta fever and 
that the disease is spread to human beings by goats. 

On June 23, 1905, Maj. W. H. Horrocks wrote the chairman of the 
commission that he had discovered the M. melitensis in the milk of 
an apparently healthy goat and that he had already found it in the 
milk of five goats taken from two different herds, and that Doctor 
Zammit had found it in the blood of one of these goats. 

Preliminary notes by Major Horrocks, Captain Kennedy, and Doc- 
tor Zammit on the propagation of Malta fever by goats show that one 
or more healthy goats in every herd are excreting the M. melitensis 
in their milk and urine, and that about 50 per cent of the goats react 
to Malta fever when examined by serum agglutination tests. The 
commission states that it may be objected that no exact proof exists 
that the drinking of milk containing the M. melitensis will give rise 
to the disease in man. However, when we take into consideration the 
results of feeding and inoculation experiments on monkeys it may be 
assumed that the disease is propagated in this way. 

This is the first statement in the literature bearing upon the propa- 
gation of Malta fever by the milk of infected goats. 

With the object of ascertaining by experimental inoculation 
whether goats could be infected by M. melitensis 6 goats from 2 dif- 
ferent herds were brought and placed in the lazaretto. Doctor Zam- 
mit a before inoculation of these goats took blood from each and 
tested their serum for agglutination. He found to his surprise that 
the serum of 5 of these goats considerably diluted caused agglutina- 
tion of the M. melitensis. The reactions thus obtained suggested that 
possibly 5 of the goats were suffering from Malta fever acquired un- 
der natural conditions. The goats were said to be healthy, but were 
sold cheaply as they had given very little milk for some time. Ex- 
amination of these goats in detail resulted as follows : 

Goat No. 6: M. melitensis appears to be steadily excreted in the 
apparently normal milk of this goat. 

Goat No. 1 : M. melitensis excreted in large number in the milk and 
also in the urine of this goat. 

Goat No. 2 : M. melitensis excreted in small quantities in the nor- 
mal appearing milk of this goat; not detected in the urine. 

Goat No. 3 : M. melitensis present in large numbers in the normal 
looking milk of this goat, but not in the urine. 

Goat No. 5 : M. melitensis was found in the milk and urine. 

Captain Kennedy, E. A. M. C., visited the various herds and took 
blood from the ears of the goats. Out of 161 goats examined 84 

° Reports of the commission * * * for the investigation of Mediterra- 
nean fever * * *. Part 1, 1905, p. 84 et seq. 



207 

gave a positive agglutination test, equal to a percentage of 52 prob- 
ably infected with Mediterranean fever. 

The results obtained show that some of the goats in every herd 
examined were suffering from Mediterranean fever. The M. meliten- 
sis is present in the milk in enormous numbers when the disease has 
been present sufficiently long to cause a change in the physical char- 
acters of the fluid. It is also excreted in considerable numbers, even 
when the animals are in " full milk " and no changes have occurred 
in either the physical or chemical characters of the milk. 

The M. melitensis is also excreted in the urine of goats suffering 
from Mediterranean fever, but up to the present it has only been 
found when the disease has existed for some time and after physical 
changes have occurred in the milk. 

Shaw examined the blood of 33 cows, 10 of which gave a positive 
reaction to the M. melitensis; from the milk of 2 of these cows the 
M. melitensis was isolated. 

The manner in which animals become infected with the virus of 
Mediterranean fever is a matter of considerable interest and im- 
portance. Up to the present all the evidence available points to 
their food as being the main vehicle of infection. The feeding ex- 
periments show conclusively that monkeys and goats may thus be 
infected. Besides the very obvious way of infection of the young 
through their mothers' milk, the successful result of various feeding 
experiments with food soiled, directly and indirectly, with the urine 
of 2 ambulatory cases of Mediterranean fever, and in whose urine 
living M. melitensis was being excreted, indicated another way in 
which these animals may be infected while feeding. Goats may be 
seen any day in the streets of the chief city of the island of Malta 
feeding on filth and rubbish of every possible variety, some of it 
visibly saturated with urine, animal and human. Among the lower 
class Maltese, as above stated, workmen have been found who void 
living M. melitensis in their urine, as do a certain number of in- 
fected goats. Thus the path of this manner of infection becomes 
clear. Having satisfied their hunger in this manner, the goats lie 
down in the streets to digest their meal with their teats and udders 
often in contact with the ordure of the gutters and roads, till they 
are kicked up by the goatherd to be milked into the vessel brought 
to the doors of the adjacent houses by their occupants. It is hence 
not to be wondered at that these animals frequently suffer also from 
suppurative mastitis and give milk containing pus. In the health 
reports of the Malta government may be seen reports of outbreaks 
of illness among children directly traced to this cause by the med- 
ical officers. 



208 

With regard to cows the evidence is not so clear. Kept shut up 
in " shippens," and seldom allowed outside, they have their food 
brought to them, but as this food is composed of vegetable and 
other refuse collected from every possible source and situation, it is 
easy to understand that they can hardly escape from receiving 
infected food from time to time. 

It was interesting to note whether those goats whose blood gave 
a positive agglutination reaction would have some symptoms of 
illness, but this was not apparent except in a few cases. The quan- 
tity and quality of the milk seemed in most cases to be unaffected. 
In fact, it was often noted that the best milk-producers in the herd 
gave a positive reaction. 

Horrocks and Kennedy a thought that as a result of their observa- 
tions, judged by the serum reaction, 41 per cent of the goats in Malta 
are infected. Ten per cent of the goats supplying milk to various 
parts of Malta appear to excrete the M. melitensis in the milk. 

The excretion of the specific microbe may continue steadily for three 
months without an} r change occurring in the physical character or 
chemical composition of the milk and without the animal exhibiting 
any signs of ill health. Some infected goats may lose flesh and their 
coats become thin ; the} r may also suffer from a short hacking cough. 
A febrile condition, however, has not been observed. Goats may 
have a marked blood reaction and yet never excrete the M. meli- 
tensis in the milk. If the blood serum or milk does not agglutinate 
the M. melitensis, the specific microbe is not found in the milk. 

The excretion of the M. melitensis in the milk may be intermittent, 
appearing for a few days and then disappearing for a week or more. 
A blood reaction may exist for some weeks before the M . melitensis is 
excreted in the milk. 

Monkeys and goats can be infected b} 7 feeding with cultures of 
M. melitensis isolated from milk, and also by feeding with infected 
milk itself. The incubation period in feeding experiments appears to 
vary between three and four weeks. Monkeys infected by feeding 
sometimes suffer from a typical wave of fever and lose flesh, at other 
times they show no obvious signs of ill health, and may even gain in 
weight. 

When monkeys become infected by feeding with milk the lymphatic 
glands always contain far more colonies of the M. melitensis than the 
spleen. This fact suggests that the specific micrococci contained in 
the food are carried to the lymphatic glands and there undergo con- 
siderable multiplication. It has not yet been proved that the mesen- 
teric glands are always infected at an earlier date than the femoral 

a Reports of the commission * * * for the investigation of Mediterranean 
fever * * * Part 4, 1906, p. 68, et seq. 



209 

and axillary glands, but feeding with milk shows that this may be the 
case at times. 

It has been demonstrated that goats may become infected by feed- 
ing on dust polluted with urine from cases of Mediterranean fever. 
The excretion of M. melitensis in the milk resulting from such infec- 
tion is a late phenomenon only appearing about seventy-four days 
after the blood reaction has developed. 

In report No. 6 of the commission they state that, reviewing the 
evidence already collected by the Mediterranean Fever Commission 
in its entirety, it is fairly obvious that the infective character of the 
milk of many of the goats upon the island of Malta affords a ready 
and reasonable explanation of the means by which the disease is 
transmitted. Then, too, the evidence yielded by experiments upon 
monkeys, supported by the facts of the steamship Joshua Nicholson 
epidemic, justifies the assumption that in the ingestion of infected 
milk we have the veritable infective agency in the vast majority 
of *cases. Additional weight attaches to this view by reason of the 
declining case incidence that was associated with the compulsory sub- 
stitution (owing to the goatherds strike) of imported preserved 
milks for the fresh goat's milk by the local and military authorities. 

In report No. 6, page 70, is an account of an outbreak of Malta 
fever aboard the steamship Joshua Nicholson which conveyed a herd 
of milk goats from Malta to Antwerp in the latter part of the 
summer of 1905. These goats were collected by a representative of 
the United States Bureau of Animal Industry for shipment to the 
United States. It reads almost as if it were a planned laboratory 
experiment, and in view of the experimental work above referred to 
established almost conclusively the relation of infected goat's milk 
to the spread of Malta fever. The following account of the outbreak 
is taken verbatim from the report of the commission : 

1. HISTORY OF THE GOATS. 

Mr. Thompson, of the United States Bureau of Animal Industry, 
visited Malta in the summer of 1905, and during a stay of some 
months gradually purchased a herd of 61 milch goats (all healthy 
in appearance and good milkers, many being prize animals), and 4 
billy goats. These he shipped on board the cargo steamer Joshua 
Nicholson, on August 19, 1905, for passage to the United States 
via Antwerp. During the voyage, which lasted until September 2, 
1906, when Antwerp was reached, the goats were milking well, and 
many of the ship's company partook freely of the milk — the officers 
drinking " mixed " milk collected in a large vessel, the members of 
the crew each obtaining " whole " milk from 1 goat in his own sep- 
arate panikin. 

45276°— Bull. 56—12 14 



210 

On arrival at Antwerp the goats were at once transferred to the 
quarantine station, where they remained for the five days that 
elapsed before they were reembarked on the steamship St. Andrew 
bound for New York, and during this voyage a large quantity of 
milk was again available for consumption. New York was reached 
about September 24, and the animals were transferred to the quaran- 
tine station at Athenia, N. J., where they remained under observation. 
Subsequent bacteriological examination resulted in the recovery of 
M. melitensis first from the milk of 2 of the goats and afterwards 
from that of several more. 

2. THE INCIDENCE OF MEDITERRANEAN FEVER AMONG THOSE 
WHO PARTOOK OF THE MILK. 

(a) In the steamship Joshua Nicholson. — In addition to 4 passen- 
gers (Mr. Thompson and 3 goatherds) present on the voyage from 
Malta to Antwerp, the Joshua Nicholson carried 23 officers and men. 
Of the crew of 19, the carpenter, boatswain, and messroom steward, 
together with others (11 in all), left the ship at Antwerp; the boat- 
swain was afterwards in hospital suffering from hernia; the move- 
ments of the remainder can not be traced. Of the 12 remaining offi- 
cers and crew, 8 fell sick at intervals varying from eighteen to thirty- 
four days from the embarkation of the goats, and in the cases of 5 of 
these 8 the blood reactions leave no room for doubt that Mediter- 
ranean fever was the cause of their illness. 

The 4 members of the ship's crew who did not show any signs 
of illness were the second mate and the cabin boy, with whom the milk 
disagreed and who consequently had but very little, and 2 engineers 
(Germans) who drank the milk, it is true, but appear to have always 
boiled it. 

Of the 3 goatherds, 1 (the chief goatherd) had undoubtedly been 
infected with M. melitensis previous to July, 1906, as evidenced by 
the presence of specific agglutinins in his blood, but whether recently 
or remotely it was impossible to say ; about the 2 assistant goatherds 
no information could be obtained. 

(b) At Antwerp. — The staff of the quarantine station and many 
individuals in the neighborhood are said to have partaken of the 
milk, both raw and boiled, during the five days the goats were in- 
terned here, but no information can be obtained of the subsequent 
occurrence of cases of illness resembling Mediterranean fever. 

(c) In the steamship St. Andrew. — The steamship St. Andrew car- 
ried 30 cattlemen and 3 goatherds, and Mr. Thompson, in addition to 
a crew of 30 men. Most of these drank of the milk, but the master of 
the ship and also his owners state that none of the men suffered from 
any illness. 



211 

(d) In America. — With the exception of Mr. Thompson, who died 
in January, 1906, from " bilateral pneumonia following influenza," 
and about whose medical history, qua Mediterranean fever, no evi- 
dence can be obtained, only 1 person — a woman at the quarantine 
station — took the milk in any quantity. She, however, drank the 
mixed milk from several goats for a considerable period, and in De- 
cember, 1905, suffered from a typical attack of Mediterranean fever. 

3. THE RESULTS. 

In summarizing the result of this unpremeditated experiment sev- 
eral factors have to be considered. For instance, a certain unknown 
number of goats — more, however, than 2 — were shown to be secreting 
infective milk after their arrival in America, some three months after 
leaving Malta, but there is no direct evidence as to the number whose 
milk contained M. melitensis during the voyage in summer weather 
from Malta to Antwerp. Arguing from analogy with average 
Maltese herds, at least 6 should have been secreting infective milk. 
The goats purchased by Mr. Thompson were, however, picked ani- 
mals and heavy milkers, and as experience has shown that the goats 
yielding the most milk in any given herd are the most likely to be 
passing M. melitensis in their milk, the probability is that in this par- 
ticular herd of 60 milch goats (1 having died the day after leaving 
Malta) the milk from considerably more than 6 was heavily infected — 
an inference which receives confirmation from the fact that the 3 
officers and the steward who drank " mixed " milk each developed an 
attack of Mediterranean fever, the remaining officer and the cabin 
boy, with whom the milk disagreed and who consequently did not 
drink it, remained well. 

The members of the crew, on the other hand, each drank " whole " 
milk from a single goat, and apart from the possibilities of the milk 
being supplied on any particular occasion from an uninfected ani- 
mal, a reference to Section I (3), shows clearly the possibilities of 
a man who obtains milk, even from an infected animal, avoiding the 
ingestion of infective milk. 

Apart from such considerations, however, it suffices to state the 
net result as follows : 

Of 23 a men on board the steamship Joshua Nicholson who drank 
on one or more occasions presumably infected milk, no evidence what- 
ever is available as to 12 and no relevant information as to Mr. 
Thompson; of the remaining 10, 1 suffered from hernia only, 1 
was infected by M. melitensis at an unknown date, while 8 suffered 

a That is disregarding the 2 men who boiled the milk before drinking it, 
and the officer and cabin boy who did not drink the milk. 



212 

from febrile attacks — 5 (or 50 per cent of them) yielding conclusive 
evidence of infection by M. melitensis. 

In Report No. 5 of the commission is an article by Major Horroks 
on Mediterranean fever in Gibraltar. The facts there detailed, taken 
with the curve showing the relation of the number of goats in 

























































































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= No . of goats. Each square equals 80 goats* 
= Malta fever. " " " 40 cases. 



Gibraltar to the number of cases of Malta fever, is particularly 
interesting and suggestive. With the reduction in the number of 
goats in Gibraltar there was also a decrease in the number of cases 
of Malta fever, so that finally when the number of goats had de- 
creased to about 200 in 1905, Malta fever has practically disappeared. 



213 

Mediterranean fever, often called " rock fever," has existed in Gi- 
braltar for many years,* although the cause of the fever was not known 
until the discovery of Bruce's specific organism from fatal cases of 
Malta fever. Physicians residing in Gibraltar knew of the existence 
of a fever characterized by long duration, low mortality, and liable 
to be followed by rheumatic sequela. 

In a study of the cases of continued fever in Gibraltar from 1882 
to 1905 it was shown by Horrocks that in the year 1884 there were 
833 cases of continued fever of which 429 were probably Mediterra- 
nean. In 1885 there were 697 cases of continued fever including 341 
cases of Malta fever. In 1886 there were only 331 cases of continued 
fever and of these 158 were enteric fever. The great increase in the 
number of cases of enteric fever was attributed partly to the arrival 
of an infected regiment in Gibraltar from Egypt and to serious sani- 
tary defects in Gibraltar. In 1887 there was again a considerable 
falling off in the number of cases of Mediterranean fever and from 
that date, with slight oscillations, the curve of Mediterranean fever 
gradually declined until it reached in 1904. The rapid disappear- 
ance of febrile diseases from Gibraltar, which commenced in 1885, 
forms a marked contrast with the state of things in Malta in cor- 
responding years. It is plain that some important factor which dis- 
appeared from Gibraltar has continued to operate in Malta. 

It has been shown that the M. melitensis is excreted in the urine of 
man and goats and that animals can be infected by dust contami- 
nated with the urine of Malta fever patients ; that the micrococcus is 
excreted in the milk of infected goats, and that the consumption of 
this milk causes Malta fever in monkeys. It is evident that both the 
sanitary conditions and the possible infection of goats in Gibraltar 
must be investigated if the cause of the continued fever is to be 
discovered. 

That the improvement of the sanitary conditions played but a 
minor part in the marked decrease in the prevalence of Malta fever 
in Gibraltar is shown by the fact that the curve representing the 
presence of Malta fever among the military population rose steadily 
from 1874 to 1884, in spite of the improvement in the sanitary condi- 
tions in Gibraltar. 

Twenty years ago goats were allowed to graze on certain portions 
of the rock and passes were granted to goat keepers for this priv- 
ilege. In 1883 passes for 1,793 goats were granted. In 1886 the 
number of passes had been reduced to 1,512 ; by 1890 the passes had 
further declined to 590, and in 1892 to only 510. From 1894 to 1902 
the number of goats appears to have changed very little ; in 1904 the 

a Reports of the commission * * * for the investigation of Mediterranean 
fever * * * Part 5, 1907, p. 55. 



214 

passes were reduced to 210, and when Major Horrocks began an 
examination of the goats in 1905 he found only 254 distributed upon 
various portions of the rock. It might be urged that, though passes 
for grazing were withdrawn, the goats were still kept and housed in 
goat sheds. This, however, was not the case, as Major Horrocks as- 
certained that in the period from 1883 to 1903 about 1,100 goats had 
been sold, and those familiar with the goat trade stated that where 
passes for grazing could not be obtained the goats were not kept in 
any numbers. 

In 1905, Major Horrocks took specimens of blood from 254 goats 
found on various portions of the rock and tested the serum for ag- 
glutination. Fourteen per cent of them gave a positive reaction 
with M. melitensis. It is extremely suggestive that the decrease in 
the Malta fever in the military population was coincident with the 
decrease in the number of goats in Gibraltar. 

It appears probable that the rapid disappearance of Mediterranean 
fever from Gibraltar, which commenced in 1885, was intimately as- 
sociated with the exodus of infected goats from the rock. Improved 
sanitary conditions, especially the disconnection of waste pipes 
and house drains from sewers, may have played a part in causing the 
decrease of fever, but as the same sanitary improvements have been 
carried out in Malta without any corresponding decline of Mediter- 
ranean fever, it is fair to assume that their effect was insignificant 
compared with that produced by the removal of the infected goats. 



6. MILK SICKNESS. 



(215) 



MILK SICKNESS. 



By George W. McCoy, 
Passed Assistant Surgeon, Public Health and Marine-Hospital Service. 



Definition. — Milk sickness is an acute, nonfebrile disease, probably 
of a specific nature due to the ingestion of milk, milk products, or 
the flesh of animals (usually cattle) suffering from a disease known 
as trembles. The disease in man is characterized by great depres- 
sion, persistent vomiting, obstinate constipation, and high mortality. 

Synonyms. — Endemic sick stomach, sloes or slows, milk sick, sick 
stomach, colica trementia, puking complaint, paralysis intestinalis, 
mukosma, syro. 

Historical. — Milk sickness was first noted and its association with 
trembles in cattle first defined about the beginning of the last century. 
The earliest professional account appears to have been published by 
Drake in 1809, and was based upon the observations of Dr. Thomas 
Barbee. Since that time the disease has become an important part 
of the medical history of our middle west. 

In some localities the disease was so prevalent and fatal that whole 
communities migrated from " milk-sick " sections to parts where the 
disease did not occur. 

Almost every community in some parts of the country has a tra- 
dition about outbreaks of this disease in the earlier years of the past 
century. We are told by Colonel Henry Watterson (1909) that Nancy 
Hanks, the mother of Abraham Lincoln, died from the disease in 1818 
after an illness of a week. In the words of Colonel Watterson, " The 
dread milk sickness stalked abroad, smiting equally human beings 
and cattle." 

With the advance of civilization, as forests were cleared and pas- 
tures fenced, the disease became less frequent; by the time of the 
civil war the disease was by no means common. At the present time 
it is one of the rarest of diseases. Trembles in animals is now almost 
as rare as " milk sickness " in man. According to Jordan and Har- 
ris (1908) an active focus of the disease exists in the valley of the 
Pecos River in New Mexico, where the disorder among animals has 
generally been attributed to " alkali poisoning." An outbreak oc- 
curred in Macon County, Tenn., in April and May, 1907. Small epi- 

(217) 



218 

demies are reported in some part of Tennessee every two or three 
years. The cases now occur only in the thinly settled regions, usually 
remote from lines of communication. Most frequently they are at- 
tended by a layman, known locally as a " milk-sick " doctor, who has 
a local reputation for curing the disease. The only modern scientific 
contribution to the literature of milk sickness is the work of Jordan 
and Harris. 

Milk sickness in man (and trembles in animals) was such an impor- 
tant question in the early years of the last century that several State 
legislatures offered liberal rewards for the discovery of the cause of 
the disease. In 1821 the legislature of Tennessee passed an act re- 
quiring fences to be made around certain coves in Franklin County 
" to prevent animals from eating an unknown vegetable, thereby 
imparting to their milk and flesh qualities highly deleterious." 

At the present time when the disease is rare many persons living 
in and near the endemic foci abstain from the use of milk and butter 
on account of the danger of contracting milk sickness. 

At the outset one is confronted with the difficulty that the affection 
under consideration is largely a matter of tradition. Satisfactory 
accounts of the disease are rare. Drake (1841), who is much quoted 
in all accounts of the disease, appears not to have been personally 
familiar with the malady; indeed, in his memoir he states that he 
has seen no case in man nor in the lower animals. Yandell (1852), 
who is also frequently quoted and has written much on the subject, 
makes no mention of having himself seen cases, and in his later publi- 
cations expresses grave doubt as to the existence of a specific disease 
corresponding to that described as milk sickness. In his own words : 
" Upon a review of the whole matter, the conclusion to which all the 
testimony on the subject has brought me is, that we, who have written 
upon milk sickness have been egregiously imposed upon by careless 
and incompetent observers." Many of the accounts, indeed I think I 
may safely say, the majority, are based upon hearsay evidence. 

A large number of the articles published on milk sickness were 
written wholly with the object of proving that a plant poison is the 
cause of the disease; many others, that a mineral poison is the 
causative agent. The disease has been described as a mild, almost 
trivial affair ; and again as most malignant and fatal. A few writers 
have regarded the disease as a manifestation of malarial poisoning. 
However, the mass of the testimony clearly indicates that there is a 
specific disease, known as milk sickness, always derived from a case 
of trembles in an animal. 

Distribution. — So far as known the disease has never occurred out- 
side of the United States. In this country it has been endemic in 
many of the newly settled regions, in practically all of the States 
south of New York, and as far west as Missouri and Arkansas. Ten- 



219 

nessee, Kentucky, Ohio, Indiana, and Illinois have suffered the most 
severely. At the present time cases occasionally occur in Tennessee 
and North Carolina. Cases have been reported in Illinois as late as 
1904. The recent discovery of the disease in New Mexico is the first 
indication we have of its occurrence west of the Mississippi Valley. 

In the endemic foci, the disease in the lower animals is limited to 
rather well-defined areas. Many of these areas are fenced to prevent 
the access and consequent contamination of stock. I have seen a 
number of such inclosures varying in size from an acre to several 
thousand acres. " Milksick Mountain," in White County, Tenn., is 
entirely inclosed by a fence 7 or 8 miles in length, built about fifty 
years ago; since which time the disease has been very rare in that 
locality. 

The infected areas are always wooded land, but otherwise vary 
markedly, from dark damp ravines to high dry ridges or ordinary 
level forest tracts. Seaton (1841), who wrote extensively on the sub- 
ject, claimed that the disease was found only where sandstone entered 
largely into the composition of the soil. Other writers do not agree 
with this view. 

There appears to be a very general agreement in the opinion that 
wooded land is essential for the existence of the disease and the clear- 
ing of the land suffices to remove all danger of animals acquiring 
trembles. It is said that if land be rendered harmless by clearing, 
then be permitted to produce a new growth of timber, the tract may 
again become the seat of the disease. So sharply are some milk-sick 
areas defined that farmers point out places where on one side of a 
fence animals may be pastured in perfect safety, whereas if pastured 
on the other side of the fence they are almost sure to contract trembles. 
I have been told of more than one outbreak of trembles due to chang- 
ing the fence of a pasture by a few yards so as to include some wild 
(uncleared) land. 

It has been claimed that springs and water courses have conveyed 
the cause of trembles, but it seems clear that in such cases the animals 
contract the disease in the surrounding wooded areas. 

Etiology and pathology. — Children appear to be less liable to the 
disease than adults. Nursing women are said to enjoy a relative im- 
munity (Johnson, 1866). One attack confers no immunity; in fact, 
it appears to predispose to subsequent attacks (Philips, 1877). 

The disease occurs most frequently in the spring and the fall, but 
records of cases in summer are not rare and a few are said to have oc- 
curred in winter. Drake (1841), who investigated the subject in 
Ohio, states that the disease occurred in May and June, but was more 
frequently met with in August, September, October, and November. 
The majority of writers agree with this, stating that cases are most 
frequent in the fall months, and especially when the season has been 



220 

dry. The last outbreak in Tennessee occurred in April, 1907, and the 
general impression prevails among physicians and laymen in that 
State that the disease occurs only in the spring and the autumn. 

So far as milk sickness in man is concerned about the only etiolog- 
ical fact of importance is that the disease occurs as a result of the use 
of milk, butter, cheese, or flesh from an animal suffering from trem- 
bles. Even this has been questioned. Yandell (1867) states "that 
the relation of the disease to animal products is not on an impregnable 
basis." The great mass of evidence, however, leaves little doubt but 
that the disease is practically always derived from a case of trembles. 

The favorite theory among physicians and laymen is that trembles 
is caused by a poisonous plant eaten by the animals. It is supposed 
that the poison is eliminated in the milk, or if the animal is not in 
lactation is stored up in its tissues. In support of this theory it is 
urged that the disease occurs only in seasons when animals are allowed 
to graze in the open, and only when they graze in certain special 
places that soon become known as milk sick. A number of plants, 
notably poison ivy, white snakeroot, and certain mushrooms, have 
been claimed to be the essential cause of the disease. These plants 
are all common in many localities that have never had milk sickness, 
and in no case does the claim that any one of them is the cause of the 
disease appear to be well founded. Indeed the flora of a milk-sick 
region may be identical with that of the adjacent healthy land. 

Next in popularity to the plant-poison theory of the cause of the 
disease is the mineral-poison theory. 

Seaton (1841) very vigorously maintained that milk sickness was 
a form of arsenic poisoning. Lead and cobalt have also been accused. 

I have been unable to bring about any condition in guinea pigs 
that even remotely resembles trembles by feeding experiments with 
cobalt, lead, or arsenic. When these animals finally succumbed to 
the poison their tissues were without any harmful effect on animals 
(guinea pigs) to which they were fed. 

Two facts, apparently well established, may be urged against either 
the plant or mineral poison theory. In the first place, the flesh of 
animals dead of either trembles or milk sickness will, when eaten by 
another animal, cause that animal to develop trembles and the dis- 
ease may again be reproduced by feeding the flesh of the second 
animal. It is said that this transference of infection may thus be 
carried through a long series of animals. In the second place, the 
observation has been made very frequently that, under natural con- 
ditions, it is only exposure at night or in the morning while dew is 
on the grass, that is capable of infecting an animal with trembles. 

The limitation of trembles to certain well-defined areas, and the 
fact that night exposure only appears to be dangerous, suggest the 



221 

possibility of the conveyance of the infection through an interme- 
diary host, such as arthropods or biting insects. 

A favorite theory many years ago was that the disease is produced 
by a gas or miasm rising from the earth in the affected region. The 
gas was supposed to be generated by earth or vegetation. At the 
present day, no discussion of this theory is necessary. 

Trembles was early recognized to have some of the features of in- 
fectious diseases. In 1843, Heeringen wrote " I am compelled to be- 
lieve that trembles belongs to the anthrax family." This was twelve 
years before the discovery of the anthrax bacillus. Mention is fre- 
quently made of the fact that the disease may be carried from one 
animal to another by feeding the flesh of a diseased animal. 

In 1877, Philips reports finding " spiral bacteria " in the blood of 
a typical case, and the same organism, with cocci, in the urine of the 
same case. He encountered similar organisms in the urine of other 
cases. 

Gardner (1880) reported finding in the blood of a heifer suffering 
from the trembles, organisms " that bore in size and behavior a 
striking resemblance to the form of bacteria called by naturalists 
bacilla subtilissima." He found the same organism in the water of 
a spring that had supplied a family in which milk sickness was pres- 
ent. Dogs suffering from " slows " acquired by eating the flesh of the 
heifer also had the organism in the blood. He also found the organ- 
ism in milk. 

Graff (1841) reported some very remarkable experimental work 
with trembles. He found the flesh of the animals not to differ mate- 
rially in appearance from that of sound animals. Salting meat, he 
says, does not impair its poisonous properties. The milk of a cow 
was poisonous, as shown by feeding it to dogs for eight days after she 
was removed from the infected pasture; but a test made a week later 
showed the milk to be harmless. He found small amounts of meat or 
butter sufficient to cause the disease. " One ounce of butter or cheese 
or 4 ounces of beef, either raw or boiled, administered three times a 
day, will certainly prove fatal within six days, and often earlier." 
All these experiments were upon dogs and the flesh of his experi- 
mentally killed dogs was as poisonous as the beef that conveyed the 
disease. 

Graff found that treating the flesh with dilute sulphuric acid for 
two hours did not destroy the poison; even heating had no effect. 
He says butter heated " to such a degree as to cause it to inflame lost 
none of its poisonous properties." He failed to extract the poisonous 
agent from meat by prolonged boiling. He failed in attempts to 
communicate the disease " by an inoculation with any portion of the 
body or secretions from infected animals." These experiments lack 
confirmation. 



222 

Jordan and Harris have isolated a micro-organism from the tissues 
and body fluids of animals suffering from trembles, which they have 
called U B. lactimorbi." The following is a brief abstract of their 
description of the bacterium : 

The organism is a motile rod, and appropriate staining demon- 
strates the presence of flagella. Spores are found under certain con- 
ditions. On an agar slant the growth is smooth, grayish, glossy, 
without pigment formation. There is a turbidity of broth at the 
end of twenty-four hours, and later a pellicle forms, which falls when 
the tube is agitated. Litmus milk is at first rendered alkaline, later 
it turns dirty- white, and finally may become opalescent. No multi- 
plication occurred on potato. On Lofflers blood . serum there is a 
smooth, yellowish growth. Gelatin is slowly liquefied. 

The nonsporulating cultures are killed by an exposure of five min- 
utes to a temperature of 55° C.J while the spore-bearing cultures are 
destroyed at 100° C. maintained for fifteen minutes. The disease 
has been reproduced in a rabbit by the inoculation of blood from an 
infected animal. Feeding experiments have shown that the dog and 
the calf may be infected with the organism, which may in turn be 
recovered from their tissues after death. These observers report 
having isolated the organism from several naturally infected cows 
and from one naturally infected horse, and Doctor Jordan informs 
me in a personal communication that they have also isolated it from 
a man and from sheep. 

It would appear from this work that another of the diseases, the 
cause of which has long been shrouded in doubt and mystery, has at 
last yielded its secret to laboratory investigation. 

Milk cows seldom show any symptoms so long as they are regularly 
milked, even though they are secreting milk fatal to man and to other 
animals; in a herd the steers and heifers always show symptoms 
before the cows that are giving milk. Buttermilk is generally re- 
garded as harmless. Graff thought differently, however. 

Apparently not all are equally susceptible, as it has frequently 
been noted that of several persons who partake of the poisonous milk 
or meat, some may escape, while others, usually the majority, will 
contract the disease. 

A recent outbreak which I have investigated had some of the con- 
ditions of an experiment on human beings. The record, unfortu- 
nately, is based entirely upon nonprofessional observation, but is, I 
believe, fairly accurate. In brief, it is as follows : Seven persons par- 
took of a meal, 6 of whom used milk and butter and became ill with 
characteristic symptoms of milk sickness and subsequently died. The 
only person who escaped was a woman who never used either milk or 
butter. One of the 6 was a guest and had only this one meal in this 
house. This individual sickened on the day after partaking of that 



223 

meal. The other 5 persons became ill at different times ; the last one 
about ten days after eating the meal that apparently poisoned the 
guest. A calf using the same milk sickened with " trembles " soon 
after the earliest cases in the family. The cow accused of imparting 
the disease developed " trembles " and died. The cow showed no 
symptoms until milking was neglected on account of illness in the 
family. It was believed that this cow had been on milk-sick land 
about two weeks prior to the outbreak. This outbreak seems to have 
been a typical one, the sickening of the cow only after she was no 
longer milked, the sickening of the calf at about the same time that 
some of the persons were attacked, the onset of the illness at a vary- 
ing period after the use of the suspected milk and butter, finally, the 
exemption of the only person who did not partake of the milk or 
butter, all agree with the older descriptions. As trembles and milk 
sickness are both so rare at present, an occurrence like this points 
strongly to a most intimate relation between them. 

The few recorded post-mortem examinations throw little light upon 
the nature of the disease. Home (1844) , who examined three human 
cases, found inflamed patches in the small intestine. The mesenteric 
glands were red and greatly enlarged. 

In animals, Graff found the brain " suffused with a large quantity 
of blood, which, from the amount contained within the cranium, must 
have made great pressure on every part." In one human case he 
found softening of the brain and evidence of meningitis. Graff tells 
us that this autopsy was conducted " by stealth at night in the open 
air, and by the light of a single candle." 

Barbee (1840) found the colon in man " contracted to the size of a 
common candle." The mucous membrane of the stomach was red and 
thickened in spots; the remainder presented a pale and softened ap- 
pearance. The peritoneal coat of the small intestines was inflamed. 

Jordan and Harris made a number of post-mortem examinations 
on the lower animals. They noted the odor of acetone when the body 
cavities were opened. This is interesting in view of the statement of 
most of the old writers that there is a peculiar and characteristic odor 
of the breath in milk sickness. The other findings in cattle were, 
briefly, as follows: 

Small amounts of fluid in pleural and pericardial sacs, numerous 
ecchymoses beneath the visceral pericardium. The heart muscle was 
paler than normal and when sections were examined general cloudy 
swelling was found. A general injection of the vessels o? the small 
intestine was present. The liver was always enlarged, purple red, 
sometimes with streaks of yellowish. Microscopical examination 
showed cloudy swelling and fatty degeneration of the organ. The 
gall bladder was usually full of dark-green bile. The liver tissue 
was very friable, occasionally yellowish red, and gave the appearance 



224 

of the " nutmeg " liver. The spleen and the kidneys were markedly 
congested. The mucous membrane of the small intestine was deeply 
injected and had much tenacious mucus adhering to it. In horses 
the lesions were similar to those described in cattle. The liver showed 
marked cloudy swelling and less fatty change than in cattle. There 
were small nodules embedded in the wall of the small intestine. 
These nodules were 4 or 5 millimeters in diameter and were elevated 
above the surface. They were found to originate in the lymph nodes 
embedded in the mucosa. 

Symptoms. — Philips (1877) and others thought that an interval of 
days or even weeks elapsed between the exposure on infected areas 
and the development of symptoms of trembles in cattle. Drake de- 
scribes the symptoms of trembles in animals as follows : 

The animal begins to mope and droop, and to walk slower than its fellows, to 
falter in its gait. If under these circumstances it should be driven, and attempt 
to run, the debility and stiffness of its muscles are immediately apparent. It 
fails rapidly, trembles, pants, and sometimes seems blind, as it runs against 
obstacles, but this may arise from vertigo; at length it falls down, lies on its 
side quivering, and is not, perhaps, able to rise for several hours, sometimes 
never. 

He also mentions a chronic form. 

The characteristic symptom, trembling, may always be brought out 
by exercising the suspected animal. It is related that cattle buyers 
never purchased animals from milk-sick districts until they had given 
them a run of half a mile or more to ascertain if they had trembles. 

When a cow is regularly milked no symptoms are likely to develop. 

In at least some instances a period of several days appears to inter- 
vene between the consumption of the poisoned milk or meat and the 
onset of symptoms in man. Spalding (1881) reports an outbreak 
where three days in one case and six days in another intervened be- 
tween suspending the use of the suspected milk and the onset of the 
symptoms. He also speaks of the onset in some cases as being 
" almost instantaneous when milk or beef is taken." It would appear 
that such cases, with very early onset, may be due to decomposition 
products belonging to the class of poisons usually called ptomaines. 

As judged by the description of most writers, the symptom com- 
plex in man appears to be fairly uniform. In describing it I will use 
freely the account of Way (1893). The onset is gradual, the indi- 
vidual tires easily, there is loss of appetite, in a day or two vomiting 
begins, the bowels are obstinately constipated, there is great abdom- 
inal distress, the tongue becomes large and flabby, the breath acquires 
a foul odor that is regarded as highly characteristic of the disease, 
the abdomen is scaphoid, there is marked visible pulsation of the 
abdominal aorta, the temperature is not elevated; in fact, it is gen- 
erally subnormal, there is always great thirst. The mind usually 



225 

remains clear, but in fatal cases, coma for several hours may precede 
dissolution. The average duration of cases is about one week. The 
cases referred to in the recent outbreak in Tennessee died in from 
two to ten days after the onset of symptoms. 

A common sequel of milk sickness is a lasting debility. I have 
seen a considerable number of persons who claimed that since an 
attack of the disease, they were incapacitated for hard work, especially 
in warm weather. 

The mortality is quite high. Physicians who have had a large 
experience with this disease tell me that at least half the cases will 
perish, even when carefully treated. Numerous family outbreaks 
are recorded where the mortality has been 100 per cent, as was the 
case in the last outbreak in Tennessee. 

Treatment. — The early settlers had worked out the very successful 
preventive treatment of keeping their animals from lands known to 
be dangerous, or what is better, to use for purposes of pasture in 
endemic foci, only " tame " lands ; that is, land from which the timber 
had been cut. It is even better to bring the land under cultivation, 
but this does not appear to be essential. 

With our present knowledge the treatment of the disease should 
be purely symptomatic. We have no specific remedy. Kest in bed, 
abstinence from food, stimulating enemeta, and a judicious use of 
stimulants would appear to be indicated. 

The treatment of cases in the early days was somewhat vigorous 
in accordance with the therapeutic customs of the day. Graff recom- 
mended free drawing of blood and the use of calomel not to exceed 5 
grains every two or three hours. Some advised a much more liberal 
use of calomel. Counter irritation over the abdomen was a favorite 
measure used to allay abdominal pain and vomiting. It was gener- 
ally regarded as essential to secure a free movement of the bowels, 
and when this had been accomplished the case was regarded as offer- 
ing a favorable prognosis. 

Drake (1841) considered blood letting of doubtful value, but ad- 
vised the free use of cathartics. Enemeta were frequently used. 
Philips (1877) used a purely expectant plan of treatment and urged 
against the use of strong purgatives. He used strychnine in liberal 
doses, apparently with benefit. 

BIBLIOGRAPHY. 

Allen. Illinois Med. Recorder, 1878-79, p. 88. 
Barbee. West. Jour. Med and Surg., 1840, p. 178. 
Beach. Transactions Ohio Med. Soc, 1884, p. 125. 
Beck. Chicago Clinic, Sept., 1905. 
Borland. An essay on the " Milk sickness," 1845. 

45276°— Bull. 56—12 15 



226 

Byford. Nashville Jour. Med. & Surg., 1855, p. 460. 

Candler. Am. Jour. Clinical Med., 1907, p. 914. 

Coleman. Phila. Jour, of the Med. and Phys. Sci., 1822, p. 322. 

Crookshank. Observations on the Milk Sickness, 1840. Phila. Jour, of the Med. 
and Phys. Sci., 1826, p. 252. 

Drake. Memoir on the disease called by the people the trembles, etc., 1841. 

Elder. Transactions Ind. State Med. Soc, 1874, p. 133. 

Gardner. St. Louis Med. and Surg. Jour., 1880, p. 288. 

Graff. Am. Jour. Med. Soc, 1841, p. 351. 

Heeringen. A discovery of the cause of the disease called by the people trem- 
bles or milk sickness, 1843. 

Home. Western Lancet, 1844, p. 454. 

Johnson. Atlanta Med. and Surg. Jour., 1866, p. 289. 

Jordan and Harris. Journal Am. Med. Assn., Vol. L., No. 21, 1908, p. 1665. 

Law. The Vet. Jour, and Ann. of Comp. Anat., 1877, p. 161. 

McCall. Am. Med. Recorder, 1823, p. 254. 

Mcllhenny. A Treatise on the Disease Called the Milk Sickness, 1843. 

Nagel. Nashville Jour, of Med. and Surg., 1859, p. 289. 

Palmer. Chicago Clinic, 1904, p. 267. 

Philips. Cincinnati Lancet and Observer, 1877, p. 130. 

Pusey. Louisville Med. News, 1886, p. 16. 

Schuchardt. Die Milch-Krankheit der Nord-Amerikaner in ihrer geschichtlichen. 
Entwickelung und in ihrem gegenwartigen Bestande. Janus, Amst, 1897-8, 
ii, pp. 437 ; 525. 

Seaton. A Treatise on the Disease Called by the People the Milk Sickness, 1841. 

Simon. Eclectic Med. Jour., 1888, p. 256. 

Spalding. West. Med. Reporter, 1881, p. 266. 

Way. Am. Jour. Med. Sc, 1893, p. 307. 

Wagaman. West. Jour. Med. and Surg., 1841, p. 234. 

Watterson. Cosmopolitan Magazine, March, 1909, vol. 46. 

Woodfin. North Carolina Med. Jour., 1878, p. 13. 

Yandell. Transylvania Jour, of Med., 1828, p. 309. West. Jour, of Med. and 
Surg., 1852, p. 374. Proc. Kentucky Med. Society, 1867-8, p. 88. 



7. THE RELATION OF COW'S MILK TO THE ZOO- 
PARASITIC DISEASES OF MAN. 



(227) 



THE RELATION OF COW'S MILK TO THE ZOO-PARASITIC 
DISEASES OF MAN. 



By Ch. Wardell Stiles, Ph. D., 

Chief, Division of Zoology, Hygienic Laboratory, Public Health and Marine- 
Hospital Service. 



Summary. — Theoretically, it is possible that certain infections with animal 
parasites may be contracted through the milk supply, but such possibility does 
not present any danger which is even remotely comparable with the danger of 
contracting typhoid through the milk. No animal parasite is known for which 
milk is a necessary transmitting medium or a necessary habitat in any particu- 
lar stage of the life cycle. Accordingly, the danger of contracting zoo-parasitic 
diseases through the milk supply is in general more theoretical than real, and 
can be prevented by the most elementary methods of cleanliness. 

There is no animal parasite known for man for w T hich cow's milk is 
either the necessary medium of transmission or the necessary habitat 
during any portion of its life cycle. The question of the relation of 
cow's milk to the zoo-parasitic diseases of man reduces itself therefore 
to the question as to what animal parasites of man are most likely to 
gain access to the milk accidentally during a stage of their life cycle 
which would render their transmission to man possible. 

In reference to this question the broad statement may be made that 
such possible cases would in general be due to the following causes : 

(a) Fraudulent practices on the part of persons in the milk trade 
in diluting the milk with water. 

( h ) The use of contaminated water either in such cases or in wash- 
ing the utensils with which the milk comes into contact. 

(c) Improper disposal of fecal matter. 

(d) Careless personal habits on the part of milk dealers, servants, 
etc., whereby the milk might, by coming into contact with their hands, 
become infected with stages in the life cycle of the parasites which 
would render transmission possible. 

(e) Carelessness w^hereby fecal material from various animals 
(particularly of dogs, rats, and mice) might gain access to the milk; 
and 

(/) Permitting cats or dogs to have access to the milk or to the 
dishes used for milk. 

(229) 



230 

From the foregoing it will be seen that the entire question under 
discussion is one of simple, elementary cleanliness, honesty, and pro- 
priety ; that when due regard is had for these three factors the danger 
of infection by animal parasites, through the milk supply, is elim- 
inated ; but that such danger increases in proportion as these factors 
are ignored. 

There is no evidence on record that any one of the foregoing possi- 
bilities has ever played an important role in producing any large 
number of cases of infection. Still it may be well worth while to 
refer to these possibilities briefly as contributing arguments in favor 
of a clean milk supply. 

(a and b) Water-borne parasites. — If contaminated water is used 
in washing milk cans or in fraudulently diluting milk it stands to 
reason that the contamination in question may be transmitted to the 
milk and through the latter it may be transmitted to the consumer. 
In this manner any obligatory or faculative water-borne zoo-parasitic 
infection (such as amebic dysentery, coccidiosis, possibly some forms 
of distomatosis, cysticercosis, hydatid diseases, eelworms, etc.), might 
be transmitted through the milk. The dangers involved are not suf- 
ficient to cause any sensation or alarm, but they are sufficiently real 
to present contributing arguments in favor of protecting milk from 
foul and contaminated water. 

(c) Improper disposal of fecal material. — When fecal material is 
not properly disposed of, the danger is present that the infection 
which it contains may be spread in various ways, as by flies, to the 
food, and thus it may gain access to man. The danger involved in 
reference to the animal parasites is not, in general, so great as it is 
in reference to the bacterial infections — such as typhoid, cholera, etc. ; 
for in case of the zooparasites the transmission in most of the in- 
stances in which it is theoretically possible could take place only when 
the organisms had reached a certain stage in their life cycle. For 
instance, a typhoid or a cholera stool would, a priori, be more danger- 
ous when fresh than when one to several weeks old, and its danger 
would decrease with age; from a case of amebic dysentery, hookworm 
disease, or eelworm infection, danger from a perfectly fresh stool 
would in general be nil ; gradually the stool would become infectious 
corresponding to the rapidity of the development of the infecting 
stage of the parasites in question; this infectiousness would increase 
to a maximum, according to conditions of heat and moisture, and 
then the inf ectivity would gradually decrease. If stools in an infect- 
ive condition are visited by flies or are washed into a water supply or 
are scattered in dust form, they can, according to the various con- 
ditions, form the basis of various zoo-parasitic infections, and should 
particles of such stools be accidentally carried to milk, the milk could 



231 

act as a mechanical bearer of the germs. In general, however, the 
chances of such method of infection seem rather remote, in so far as 
the animal parasites are concerned. 

(d) Personal habits of persons who handle milk. — It seems possi- 
ble that the personal habits of persons (such as milkers, servants, 
etc.), who come into more or less close contact with milk, might be a 
more appreciable element than any of the foregoing in infecting the 
milk, although even in such cases the infection in question, namely, 
by animal parasites, would be of far less importance than a typhoid 
infection. For instance, while a milker who is a typhoid " bacillus 
carrier " would be an element of grave danger to the public health, 
an infection (in that person) of pinworm, of pork tapeworm, and 
perhaps of Cochin China diarrhea, might be of some slight impor- 
tance, in reference to the possibility of their transmission through the 
milk supply ; but if that person had coccidiosis, the fat, or the broad 
tapeworm, or flukes, eelworms, or whipworms, such infections would 
be without significance, so far as the public milk supply is concerned. 

(e) Fecal material from animals. — It is not a pleasant thought 
that our milk supply may contain fecal material from various ani- 
mals, but such is unfortunately the case. Upon several occasions 
other divisions in this laboratory have submitted to the Zoological 
division for determination, sediment taken from bottled milk and 
such sediment has proved to be feces from rodents — either rats or 
mice. Now it is supposed that at least 3 intestinal parasites from 
the rats and mice are capable of developing directly in man. In the 
case of one of these parasites (dwarf tapeworms) , the usually accepted 
view is open to question, since the form in man is perhaps specifically 
distinct from the form in rodents; in the case of a second parasite 
(the trichina worm), the transmission from rat's feces to man is 
probably possible, but more theoretical than practical ; in the case of 
a- certain protozoan infection (Lamhlia) it is quite possible that a 
real, though perhaps not very frequent danger is present of its trans- 
mission through the milk supply. 

(/) Infections from dogs and cats. — Probably the greatest danger 
of the transmission of parasites from dogs and cats through the milk 
supply lies in the accidental infection with hydatids, from contamina- 
tion with canine feces, and the accidental presence, in milk, of the cat 
and dog flea, in which a larval tapeworm occurs which is transmissible 
to man. In neither case, however, is any instance of these parasites 
positively traced, so far as I know, to this method of infection, 
although such method must be admitted as theoretically possible. 



8. MORBIDITY AND MORTALITY STATISTICS AS 
INFLUENCED BY MILE. 



(233) 



MORBIDITY AND MORTALITY STATISTICS AS INFLUENCED 

BY MILK. 



By J. M. Eager, 
Assistant Surgeon-General, Public Health and Marine-Hospital Service. 



The influence of milk on morbidity and mortality furnishes a 
striking example of the potency for evil of a thing designed for the 
accomplishment of good. The food of the new-born and the most 
important aliment of the sick and the aged becomes too often a pro- 
moter of disease and an instrument of death. This malign influence 
of impure milk or milk improperly used is made evident by the 
mournful proofs of the extensive and growing statistics on the 
subject. 

QUANTITIES OF MILK CONSUMED. 

The importance of the role played by milk in the causation of 
disease is emphasized when attention is drawn to the enormous 
quantities of milk consumed. Based on the Twelfth Census of the 
United States taken in the year 1900, the milk and cream sold in 1899 
by farmers, deducting the quantities purchased by butter and cheese 
factories and condensed-milk establishments, was equivalent to about 
740,000,000 gallons of milk. This quantity of milk consumed by the 
nonfarming population in a single year was as great as the quantity 
of water supplied to the city of Washington in about ten days. The 
average quantity of milk purchased by the urban and suburban popu- 
lation of the United States is 23 gallons a year for each person. The 
consumption of milk in Philadelphia during the year 1905 was esti- 
mated at 23 gallons for each inhabitant; and in London, England, 
during the year 1892, at 11.5 gallons. 

MILK AND DISEASE. 

Health may be influenced by cow's milk either because the milk is 
physiologically unsuitable, as for infant feeding, or because it has 
become a medium of infection. Milk of inferior nutritive value can 
not be without its effect on the health of the consumer, especially when 
used as a food for babes. This effect is difficult to show statistically. 

(235) 



236' 

Its potency is nevertheless evident from a statement by J. Wicliffe 
Peck, chemist to the Hospital for Sick Children, London, that the 
average quality of milk offered for sale throughout London is so 
defective in fat and nonf atty solids that a child at six months, whose 
weight should increase about 4 ounces weekly, suffers each week a loss 
in diet of 3J ounces of fat and nonfatty solids when its ration of 
fraudulently manipulated cow's milk is based on the supposition that 
the milk is of standard quality. Such low standard milk tends to 
produce marasmus and rickets. Marasmic children present a decided 
predisposition to bronchitis and summer diarrhea and thus indirectly 
an increase of infant mortality is brought about by diluted or 
adulterated milk. 

STATISTICS OF INFANTILE MORTALITY. 

The malign effects of hand feeding of infants and the consequent 
impress made upon the mortality returns become manifest by an 
examination of vital statistics, but to gauge the exact ratio of infant 
deaths resulting from artificial feeding is very difficult. 

The reports of the United States Census Office on mortality f or.the 
year 1905 show that in the registration area with a population of 
33,757,811 there were, of 545,533 deaths at all ages from all causes, 
105,553 deaths among infants under one year of age. Diarrhea and 
enteritis caused the death of 39,399 infants in the first year of their 
life. In England and Wales all the deaths registered during the same 
year numbered 520,031 and were in the proportion of 15.2 per 1,000 
persons living. The deaths of infants under one year of age were in 
the proportion of 128 per 1,000 births in the year as compared with 
150 per 1,000, the mean proportion in the years 1895 to 1904, inclusive. 
The proportion of infant deaths in England and Wales during the 
year 1905 is the lowest then recorded, although closely approximated 
in some previous years. 

Commenting upon the official statistics of infantile mortality the 
Registrar-General of England writes: 

It has frequently been pointed out in the reports that although the general 
mortality in this country has steadily fallen in the course of the last half cen- 
tury, nevertheless infants in the first year of life have not shared in the benefit. 
About one-fifth part of the total loss of life in the first year after birth takes 
place within a week of that event, while by the end of the first month the pro- 
portion reaches one-third, and by the end of the third month it exceeds one-half. 
From the first to the fourth month diarrheal diseases steadily increase in de- 
structiveness, after which month they become gradually less fatal, although 
they still contribute seriously to the death rate throughout the first year of age. 

The rate given for the whole of England and Wales does not fairly 
represent the infant mortality of the cities of England. It was stated, 
for example, at the annual meeting in 1906 of the subscribers to the 



237 

Children's Hospital at Pendleberry that the death rate of infants 
under one year during the decade ending 1903 was 183.8 in Manchester 
and 198.3 in Salford. 

The following statistics from various countries are along the same 
lines : 



Country. 



General mortal- 
ity — Deaths to 
1,000 living; aver- 
age annual rate in 
10 years (1895-1904) 



Russia (European) . 

Chile 

Spain 

Hungary 

Ceylon 

Roumania 

Austria 

Servia 

Bulgaria 

Italy 

Jamaica 

German Empire 

Prussia 

Japan 

France 

Finland 

Switzerland 

Ireland 

Belgium 

Scotland 

England and Wales. 
The Netherlands . . . 

Denmark 

Sweden 

Norway . -. 

Western Australia.. 

Victoria 

Tasmania 

Queensland 

New South Wales. . . 

South Australia 

New Zealand 



«33.6 
28.8 
27.8 
27.3 
26.8 
26.8 
25.2 
23.9 
23.9 
22.7 
22.4 
20.8 
20.5 

&20.5 
20.4 
18.7 
18.1 
18.0 
17.8 
17.8 
17.2 
17.0 
15.8 
15.8 
15.1 
14.6 
13.3 
11.8 
11.8 
11.7 
11.5 
9.8 



Country. 



Infantile mortal- 
ity—Deaths of 
children under 1 
year to 1,000 births 
-average annual 
Rate in 10 years 
(1895-1904) . 



Chile 

Russia (European) . 

Austria 

Roumania 

Hungary 

Prussia 

Spain..! 

Jamaica 

Italy 

Ceylon 

Belgium 

France 

Servia 

Japan 

England and Wales 
The Netherlands . . . 
Western Australia.. 

Bulgaria 

Switzerland 

Finland 

Denmark 

Scotland 

New South Wales . . 

Victoria 

Ireland 

South Australia 

Queensland 

Sweden 

Tasmania 

Norway 

New Zealand 



6 326 

a 268 

C224 

d218 

216 

197 

el82 

176 

170 

169 

156 

153 

154 

a 151 

150 

147 

147 

&144 

142 

134 

127 

126 

108 

105 

103 

102 

101 

&98 

94 

90 

79 



"Average for 10 years (1892-1901). 
"Average for 10 years (1894-1903). 
c Average for 8 years (1895-1902). 



<* Average for 10 years (1890-1899). 
e Average for 5 years (1900-1904). 



Balestre and St. Joseph, in a study of mortality in early infancy 
in the urban population of France from 1892 to 1897, give a mass of 
valuable data bearing on the appalling annual toll exacted from 
the infant population of France — a loss of life which in conjunction 
with the unusually low birth rate in France has given the question 
of infantile mortality in that country a national importance. 



238 



Infantile mortality in France. 
[1892 to 1897, inclusive.] 



Place. 


Deaths at all 

ages from all 

causes. 


Deaths of in- 
fants under 1 
year per 1,000 
of all deaths at 
all ages. 


Deaths from 
diarrhea and 
gastro enteritis 
of infants un- 
der 1 year per 
1,000 deaths un- 
der 1 year from 
all causes. 


Paris, population 2,511,629 


303, 206 
322, 129 
334,032 
790,576 


145. 35 
184. 73 
167.25 
168. 13 


380. 30 


11 cities between 100,000 and 500,000 inhabitants having 


420. 49 


47 cities between 30,000 and 100,000 inhabitants having 
a combined population of 2,421,820 


350. 06 


622 cities of less than 30,000 inhabitants having a com- 
bined population of 5,892,034 


(a) 





Not recorded. 



In Paris and the cities of France having over 30,000 inhabitants 
the deaths from diarrhea by months per 1,000 infants under 1 year 
dying from all causes were as follows: 



January 212. 8 

February 211. 1 

March 224. 8 

April 254. 8 

May 303. 1 

June 426. 4 



July 587. 1 

August 606. 4 

September 537. 7 

October 431.5 

November 304. 6 

December 235. 9 



It is seen from these figures that, though the months of June, July, 
August, September, and October present the most deplorable propor- 
tion of deaths from diarrhea, this cause is not negligible in autumn 
and winter. 

In Germany, according to Behring, of every 1,000 children born 
alive 235 succumb during the first year of life. Only 510 out of 
1,000 males born attain manhood. Not more than a third of those 
reaching maturity are found to be fit for military service. These 
sad facts Behring attributes very largely to the ulterior effects of 
infection derived in infancy from milk. 

DIARRHEAL DISEASE AND MILK. 

The statistics given show how large a proportion of all deaths are 
among infants. It has been said that there is only one other period in 
life in which the chance of death is greater than it is under 1 year, 
namely, in persons over 90 years old. It is seen also that no cause is so 
prolific among children in the first year of life as disease of the diges- 
tive organs. Diarrheal diseases of infants are generally accepted to be 
due to impure food ; but there is no reason to believe that the alimen- 
tary canal of the average infant is often incapable of digesting the food 
necessary for growth and development when the food supplied is of 



239 

suitable quality and quantity. During the first year of its life a child 
consumes about 500 quarts of milk. There is ample evidence to show 
that the proportion of deaths among infants is greatly reduced when 
they receive the food nature designed for them, namely mother's milk, 
or when, as a substitute therefor, the most exact imitation is provided 
with due care to prevent its infection. There is no doubt that the 
nursing of all infants by healthy mothers would contribute immensely 
to the reduction of the infantile death rate. Observations in many 
parts of the world confirm this conclusion. 

MOTHER'S MILK AND LESSENED INFANTILE MORTALITY. 

Casper in 1825 recorded that a trustworthy traveler, von Schubert, 
says that the high death rate among young children in Norway and 
Northern Sweden in the early part of the last century was very evi- 
dently due to feeding infants with cow's milk instead, of mother's 
milk. At present, breast nursing is altogether the custom throughout 
Norway, insomuch that Borchart quoting statistics in 1883 says that 
in Norway and Scotland where suckling of infants is the rule, out 
of 100 children born 10.4 for Norway and 11.9 for Scotland die, 
whereas in Wurtemberg, where mothers as a rule are not in the habit 
of suckling their infants, 35.4 per cent perish in the first year of life. 
W. J. Tyson states that of all infants who die in England in the 
first year of life three- fourths have been fed artificially, and Doctor 
Hope, medical officer of health of Liverpool, says that according to 
his observation sanitary conditions have no marked influence on 
infant mortality, but that the methods of infant feeding are chiefly 
responsible for the high rate at which it is maintained. 

Newsholme, with a view to determining the relation of mortality 
to artificial feeding, gives a census of an infant population of 1,259 in 
10,308 houses in Brighton, England, taken in a house-to-house inspec- 
tion in the three years 1903-5, inclusive, combined with an inquiry 
into the manner of feeding of 121 babes dying of diarrhea and be- 
longing to the same social stratum as those forming the sample popu- 
lation. He concludes from these inquiries that, taking the whole of 
the first year of life, the number of deaths from epidemic diarrhea 
among breast-fed babes is not much more than one-tenth the number 
among artificially fed infants. Considering separately infants aged 
from 6 to 9 months, bearing in mind the fact that breast-fed babes 
at this age must have been breast-fed from birth, he finds that 57 
per cent of such babes were entirely and an additional 17 per cent 
partly breast-fed. Not one of the deaths at the age in question oc- 
curred among breast-fed or partially breast-fed children. 

By a similar inquiry the results obtained at Brighton were con- 
firmed in the borough of Finsbury, England, by an investigation by 



240 

Sandilands in which the method of feeding of 695 infants was investi- 
gated. It was ascertained that of 139 infants under 9 months of age 
dying of diarrhea 16 per cent only were breast fed. Of the survivors, 
69 per cent were breast-fed. 

France furnishes facts of the same import. In 1898, when diar- 
rhea made many victims among the children of Paris, it was estimated 
that the number of deaths of artificially fed infants was double that 
of the breast fed at all times during the year and that in August it 
ran up to 8 times that of the breast fed. 

Before a deputation, in 1906, of the Queensland government on the 
subject of infant life protection, Turner reported that during the 
summer months at Brisbane, Australia, more than one-half of the 
bottle-fed babes die. 

INFANTILE MORTALITY A CLASS MORTALITY. 

Harrington points out that infantile mortality is a class mortality, 
highest as a rule in cities and towns where women work in industrial 
establishments and put their children early to the bottle. In an ar- 
ticle written in 1906 he gives a table prepared from the United States 
census in which mill towns in New England are shown to have the 
greatest infantile mortality. 

Reid, as a result of a careful inquiry made in 1906, shows that the 
infantile mortality rates are in great excess in the northern artisan 
towns of Staffordshire, England, where pottery is the chief industry 
and women, both married and single, are engaged in factory labor. 
This excess is very marked where a comparison is made with the 
southern towns of the county where mining and iron-working pre- 
vail, affording practically no employment for Avomen. The general 
conditions which operate in causing a high infantile mortality pre- 
vail, it is pointed out, to an equal extent in the two populations. The 
difference in the death rate among infants in the two sections is at- 
tributed to the nature of the trades as affecting the employment of 
women away from home, with the consequent effect on the proportion 
of breast-fed and bottle-fed infants. The percentage of female mar- 
ried and widowed factory workers to the whole female population be- 
tween the ages of 15 and 50 years was studied in different localities. 
In 5 towns in which the percentage of such women so employed was 
12 or more the infantile mortality was 198 per 1,000 ; in 13 towns in 
which the percentage was under 12 and over 6 the infantile mortality 
was 156, and in 8 towns in which the percentage was under 6 the in- 
fantile mortality was 149. 

While the relation between factory labor for women and the death 
rate of young children seems well established for Staffordshire the 



241 

statistics of 1,000 towns given by the Registrar-General of England 
for 1905 do not show such a relation throughout England, to be 
intimate. 

UNNECESSARY HAND FEEDING. 

Although it might seem useless to repeat what the greatest medical 
authorities have so often asserted it is interesting nevertheless to con- 
sider to what extent hand- feeding, with its melancholy impress on 
vital statistics, is an absolute necessity. Madame Dluski, in a thesis 
delivered at the Baudelocque Clinic, Paris, expresses the opinion that 
among 100 healthy women, when the necessary conditions of alimenta- 
tion and repose are present, 99 are actually able to nurse their off- 
spring. She concludes that women, almost without exception, can 
nurse their babes ; that four-fifths of mothers can do so from the be- 
ginning of lactation; that nearly all can do so after a longer or 
shorter time, and that absolute agalactia does not exist. Yet despite 
all efforts to promote the practice of breast-feeding a great propor- 
tion of infants are uselessly bottle fed. Indeed the practice of feed- 
ing infants with the milk of animals (goats and cows) is of great 
antiquity — the Greeks and Scythians had recourse to it — but it is be- 
lieved to be greatly increasing in modern times. 

SCIENTIFIC ARTIFICIAL FEEDING AND THE MORTALITY RATE. 

In consequence of the great diffusion of the practice of artificial 
feeding for infants it is interesting to study the effect on morbidity 
and mortality statistics of a scientifically compounded artificial diet 
compared with a diet too often ignorantly or carelessly prepared. 
The statistics of the pasteurization of milk throw much light on the 
subject, 

THE STRAUS PASTEURIZED MILK DEPOTS. 

Pasteurized milk was first made available for infants in general in 
New York City in 1893, in which year Nathan Straus dispensed 
34,400 bottles of milk so prepared from one depot. In 1894 339,494 
bottles were issued, in 1895 666,622, and in 1896 666,941. In 1905 
2,668,397 bottles were dispensed and 1,016,731 glasses of pasteurized 
milk were bought at the booths in the parks of New York City. In 
1906 17 Straus stations dispensed 3,142,252 bottles of pasteurized milk 
and 1,078,405 glasses. 

Prior to the beginning of this work the death rate of children under 
5 years in New York City was over 96.2 out of every 1,000 and in 
June, July, and August the death rate of children was at the rate of 
136.4 per 1,000 per annum. With the increased use of pasteurized 
milk the death rate fell to 55 per 1,000 in 1906, and the summer death 
rate to 62.7 per 1,000. 

45276°— Bull. 56—12 16 



242 



These figures, year by year, are given in the following table, com- 
piled from the official statistics of the New York Department of 
Health : 

Population, deaths, and death rate of children under 5 years. 



Year. 


Population. 


Deaths. 


Death 
rate per 
1,000 per 
annum. 


1891 


188, 703 
194, 214 
199,885 
205,723 
212,983 
217, 071 
221,339 
225,804 
230,480 
235, 585 
242, 747 
250, 153 
257,813 
265, 738 
273,938 
282, 423 


18, 224 
18,684 
17,865 
17,558 
18,221 
16, 907 
15, 395 
15, 591 
14, 391 
15,648 
14,809 
15,019 
14,402 
16, 137 
15, 287 
15,534 


96.5 


1892 


96.2 


1893 


89.3 


1894 


85.3 


1895 


85.5 


1896 


77.9 


1897 


69.6 


1898 


69.1 


1899 


62.5 


1900 


66.4 


1901 


61.0 


1902 


60.0 


1903 


53.3 


1904 


60.7 


1905 


55.8 


1906 


55.0 







FOR THE MONTHS OF JUNE, JULY, AND AUGUST. 



1891 
1892 
1893 
1894 
1895 
1896 
1897 



1900 
1901 
1902 
1903 
1904 
1905 
1906 



188, 703 


5,945 


194, 214 


6,612 


199,886 


5,892 


205, 723 


5,788 


212,983 


6,183 


217, 071 


5,671 


221, 339 


5,401 


225,804 


5,047 


230, 480 


4,689 


235,585 


4,562 


242,747 


4,642 


250, 153 


4,389 


257,813 


4,037 


265, 738 


4,805 


273,938 


4, 892 


282, 423 


4,426 



126.4 

136.1 

117.0 

112.6 

116.1 

104.5 

97.6 

89.4 

81.4 

77.4 

76.5 

70.2 

62.6 

72.3 

71.4 

62.7 



For the purpose of comparison, the figures are confined to the orig- 
inal city of New York — now the Boroughs of Manhattan and the 
Bronx. 

At the rate of mortality of 1892, there would have been 27,169 
deaths of children under 5 years in 1906, instead of 15,534. Thus the 
apparent saving in one year was 11,635 lives, or 42.82 per cent. At 
the summer mortality rate of 1892, death would have claimed 9,743 



243 

victims in June, July, and August, 1906, instead of 4,426. Thus the 
apparent saving of lives in three months was 5,317, or 54.57 per cent. 
It must not be overlooked that in New York City, coincidently 
with the introduction of pasteurized milk, other agencies became 
operative, as for example general milk inspection by the local health 
authorities, the use of diphtheria antitoxin, the campaign of fresh 
air for children, improved tenement houses, cleaner streets, more 
parks and playgrounds, recreation piers, and other factors accom- 
panying the enlightenment in hygiene so widely spread in recent 
years, not only in New York City, but throughout the whole country. 

STATISTICS OF RANDALL'S ISLAND. 

When the infants in the care of the city of New York were fed on 
milk from a carefully selected herd pastured on the island, the death 
rate was as follows : 





Children 
treated. 


Number 

of 
deaths. 


Percent- 
age. 


1895 


1,216 
1,212 
1,181 


511 
474 
524 


42.02 


1896 


39.11 


1897 


44.36 






Total 


3,609 


1,509 


41.81 







A pasteurizing plant was installed in the early part of 1898. 
other change in diet or hygiene was made. 



No 





Children 
treated. 


Number 

of 
deaths. 


Percent- 
age. 


1898 


1,284 

1,097 

1,084 

1,028 

820 

542 

345 


255 
269 
300 
186 
181 
101 
57 


19.80 


1899 


24.52 


1900 


27.68 


1901 


18.09 


1902 


22.07 


1903 


18.63 


1904 


16.52 






Total 


6,200 


1,349 


21.75 







Had the ratio of deaths for the three years, 1895, 1896, and 1897, 
been maintained in the seven years from 1898 to 1904, the total infant 
mortality would have been 2,592, instead of 1,349, a difference of 1,243. 

STATISTICS OF MILK CHARITIES ABROAD. 

Writing of infantile mortality and the supply of humanized steril- 
ized milk, Hope states that at the Liverpool infant milk depots for 
three years ending with the year 1903, among 4,453 infants provided 



244 

with the depot milk the mortality rate was 78 per 1,000, compared 
with the following infantile mortality rate in the city of Liverpool : 



Year. 


Infantile 
mortality. 


1901 


188 
163 
152 


1902 


1903 


Average . . . 


167.6 



Harris has prepared the following comparative table showing re- 
sults of the St. Helens depot in the town of St. Helens, England : 



Year. 


Number of 

children 

on the 

books. 


Death rate 
per 1,000 

among 
children at 

depot. 


Infantile 
death rate, 
boroughof 
St. Helens. 


1899 


232 
332 
282 
200 


103 
102 
106 

82 


157 


1900 


188 


1901 


175 


1902 


167 







Lederer states that as a result of the system of pasteurization in 
practice in Vienna for the past seven years the proportion between 
the mortality rates for breast-fed and bottle-fed children which for- 
merly was 1 to 20 is in latter years between 1 to 5 and 1 to 8. It is 
observed that in Vienna the improvement in artificial diet reduces the 
mortality in the second year of life also. 

In France there are two types of organizations, the Consultation de 
Lait and the Goutte de Lait, having for their object the encourage- 
ment of breast feeding wherever possible and a supply of properly 
prepared milk to those infants for whom breast feeding is impractica- 
ble. At the Consultation de Nourissons of the Clinique Tarnier, 
Paris, the annual mortality rate during a period of about six years 
among 712 children who attended the Consultation from birth for an 
average period of nine and one-half months was 46 per 1,000. Ref- 
erence for comparative purposes to the death returns of Paris during 
the years 1898, 1899, and 1900, shows that there was a mortality of 
178 per 1,000 among infants under 1 year of age.. 

MILK AS A DIET FOR THE SICK. 

The influence of impure milk on the duration of sickness and on 
the death rate when milk is employed as an invalid diet is difficult 
to demonstrate statistically. For the sick, milk — usually uncooked 
milk — is often a principal or an exclusive article of diet. Consider- 
ing the increased susceptibility of feeble and aged persons to infection 



245 

and the diminished resistance offered by the sick, there can be no doubt 
that contamination of milk is a factor that plays a part in keeping up 
the rate of sickness and death. 

MILK AND TUBEKCULOSIS. 

The report of the United States Census Office on mortality for the 
year 1905 shows that deaths from all causes in the registration area 
were in the proportion of 1.616 per 100,000. Tuberculosis in all its 
forms caused 193.6 deaths per 100,000. Applying the same rate 
throughout the United States, it may be justly estimated that tuber- 
culosis causes over 160,000 deaths a year in the United States. 

At the International Congress on Tuberculosis held in London in 
1901, Koch made the announcement that bovine tuberculosis is trans- 
missible to the human subject to only a slight extent if at all. The 
doubt thus cast on the relation between cow's milk and tuberculosis 
has to a great extent disappeared on further investigation made by a 
host of observers, most prominent among whom is von Behring. who 
claims that milk fed to infants is the chief cause of tuberculosis in 
man. 

Schroeder and Cotton in a recent bulletin of the Bureau of Animal 
Industry conclude that the assertion that tuberculosis is a negligible 
quantity in the measures that must be taken for the preservation of 
human health is without basis and that there is no more active agent 
than the tuberculous cow for the increase of tuberculosis among ani- 
mals and its persistence among men. 

The rarity of primary intestinal tuberculosis, on which subject 
there is a discrepancy of statistics, is not in favor of the theory of 
infection by ingestion. It has been, however, repeatedly proA 7 ed that 
tubercle bacilli may pass through a mucous membrane without leav- 
ing traces at the point of entrance. Again it has been demonstrated 
by competent observers that tubercular infection may take place 
through the tonsils. Latham estimates that not less than 25 to 30 per 
cent of the cases of tuberculosis which occur in early childhood are 
due to intestinal, and therefore presumably to food, infection. Of 
deaths in 1905 from all forms of tuberculosis in the registration area 
of the United States, about 1 in 39 was among infants under 1 year 
and 1 in about 14 among children under 5 years of age. 

Ravenel writing in 1898 says : 

In northern Norway, Sweden, Lapland and Finland where reindeer con- 
tribute the bulk of farm animals, or about Hudson Bay and the islands of the 
Pacific, where there are only a few cattle, tuberculosis is far less prevalent in 
man. In Algiers the cattle are few and live for the most part in the open air 
and away from cities and it is found that tuberculosis does not increase among 
the natives. In Italy, on the other hand, where cattle are housed, Perroncito 
states that tuberculosis has become the scourge of man and beast. 



246 



Kegarding the conveyance of tuberculosis in the colder countries, 
Cobb points out that an absence of tuberculosis does not necessarily 
follow the absence of milk from the dietary. He shows on trust- 
worthy evidence that the Alaskan Indian, including the Esquimo and 
Aleut, is the victim of consumption of the lungs to a great and in- 
creasing extent, though these people do not use to any extent milk of 
any kind as an article of diet, and cow's milk not at all. Of interest 
in this connection is the report made in 1906 by the medical officer 
of health of the city of London showing that at least 8 per cent of the 
milk sold within the city limits of London is derived from animals 
affected with tuberculosis, and that of 500 cows examined after 
slaughter by the city veterinarian evidence of tuberculosis was found 

in 46.8 per cent. 

EPIDEMICS CAUSED BY MILK. 

In epidemics caused by milk (typhoid fever, scarlet fever, diph- 
theria, etc.), the mortality of the disease does not appear to differ 
from that of the same disease otherwise conveyed. The effect of milk 
epidemics on morbidity and mortality returns may be surmised by 
the frequency with which epidemics of such a character occur. 

MILK AND TYPHOID FEVER. 

Raudnitz, of Prague, states that one-fourth of the epidemics of 
typhoid fever in Austria are traceable to contaminated milk, and Mc- 
Crae records that an inquiry into the causation of 638 epidemics of 
typhoid fever showed that in 17 per cent the infection was conveyed 
by milk. The bearing of this observation on the general sick and 
death rate is obvious when it is considered that the mortality in ty- 
phoid fever, though often as low as 5 per cent in private practice, 
sometimes reaches 20 per cent. Typhoid fever causes more deaths 
than any of the other epidemic diseases. The United States census 
reports show that in 1905 there were 28.1 deaths from typhoid fever 
per 100,000 population. The death rate from typhoid fever was 
smaller in 1905 than in any of the five preceding years. The annual 
average for the registration area of the United States, 1900 to 1904 
inclusive, was higher than that for any of the countries given in the 
following table except Italy : 

Deaths from typhoid fever per 100,000 of population. 



Country. 



Registration area of United States 

England and Wales 

Scotland 

Ireland 

Germany 

Norway 



Annual 

average, 

1900 to 1904. 



33.7 
12.9 
12.7 
14.2 
8.5 
6.2 



Country. 



Sweden 

Hungary 

Belgium 

Switzerland 
Italy 



Annual 

average, 

1900 to 1904. 



12.2 
28.3 
20.2 
6.5 
37.8 



247 

SCARLET FEVER AND DIPHTHERIA. 

The number of epidemics of scarlet fever and diphtheria where the 
infection was conveyed by milk show unmistakably that the effect on 
morbidity and mortality rates thus brought about by milk must be 
considerable. While the death rate is low among patients of the 
better classes, in hospitals and among the poor it ranges from 5 to 30 
per cent, a marked variability of the death rate in different epidemics 
being a characteristic of scarlet fever. The general mortality of 
scarlet fever is shown by the following table: 

Number of deaths from scarlet fever per 100,000 population. 



Country. 


Annual 

average, 

1900 to 1904. 


Country. 


Anuual 

average, 

1900 to 1904. 


Registration area of United States 


11.8 
12.7 
10.8 
4.7 
23.7 
5.8 
8.7 


Hungary 


67.5 


The Netherlands 


2.6 




Belgium 


16.3 






3.7 




Spain 


5.9 




Italy 


4.6 


Sweden 











Diphtheria and croup caused an annual average of 33.6 deaths per 
100,000 in the registration area of the United States, 1900 to 1904. 
Among the means of transmission of diphtheria infected milk is a 
well-recognized medium. 



DISEASES OF CATTLE. 

Numerous other diseases in the transmission of which milk is a 
factor exert an effect on vital statistics. Milk sickness, a disease 
related to the affection in cattle known as the trembles, still occurs 
in certain parts of the United States. It is transmitted by milk and 
milk products as well as the flesh of diseased animals. In some of 
the Western States in early days it was a prominent disease and 
killed many of its victims. 

Foot and mouth disease in the cow has been frequently transmitted 
to human beings by the use of milk and milk derivatives. In one 
epidemic thus brought about the death rate was 8 per cent. 

ASIATIC CHOLERA. 

Milk is not infrequently a means of communicating Asiatic cholera. 
The evil efficacy of milk thus infected in its influence on morbidity 
and mortality statistics can be readily conjectured, when the desola- 
ting death record of cholera is reviewed and the almost universal use 
of milk considered. 



248 

EEFEEENCES. 

Balestre and Saint Joseph. 1901. Etude sur la mortal ite de la premiere 
enfance dans la population urbaine de la France de 1892 a 1897. Paris. 

Borchardt. 1883. Infant mortality and the milk supply. Med-Chir. Journ., 
v. 3, pp. 401-407. 

Budin, Pierre. 1905. Hygiene du Nourrisson. Paris. 

Casper, Joh. Ludw. 1825. Beitrage zur medicinischen statistik und Staatsarz- 
neikunde. Berlin. 

Census Report. 1902. Twelfth Census of the United States, taken in the year 
1900. Agriculture, Part 1, Farms, Live Stock and Animal Products. Wash- 
ington. 1907. Mortality statistics, 1905. Washington. 

Cobb, J. O. 1904. Is milk a factor in the spread of tuberculosis? N. Y. Med. 
Journ. and Phil. Med. Journ. Aug. 13, p. 304. 

Davis, J. B. 1817. A cursory inquiry into some of the principal causes of 
mortality among children, etc. London. 

Duffield, G. 1904. Milk in its pathological relations. Journ. Mich. Med. Soc, 
v. 3, pp. 70-72. Detroit. 

Fortescue-Binck, J. M. 1906. The influence of milk supply on infant mortality, 
Journ. of Royal San. Inst. p. 413. 

Freeman, R. G. 1896. Milk as an agency in the conveyance of disease. Med. 
Rec, Mar. 28. 1903. The reduction of the infant mortality in the City 
of New York and the agencies which have been instrumental in bringing it 
about. Med. News, p. 433. 

Harrington, Charles. 1906. Infantile mortality and its principal cause — dirty 
milk. Am. Journ. Med. Sc, Dec, p. 811. 

Lancet. 1906. Editorials, Mar. 31, and Apr. 28. London. 

Latham, Arthur. 1903. The diagnosis and modern treatment of pulmonary 
consumption. London. 

Lederer, Ernst J. 1907. The milk supply of Vienna. Med. Rec, June 15, p. 986. 

McCrae, Thomas. 1907. Typhoid fever. Modern Medicine. 

Medical Society of New Jersey, transactions of. Report of Committee on cows' milk. 

Miller, D. J. M. 1906. The dangers that may lurk in ordinary milk and the 
duty of the physician to educate the public and the authorities in the 
necessity of a pure milk supply. N. Y. Med. Journ. Sept. 22, p. 595. 

Newsholme, A. 1906. Domestic infection in relation to human diarrhea. 
Journ. Hyg., Apr. 

Osier, William. 1905. The principles and practice of medicine. New York 
and London. 

Raudnitz, R. W. 1907. The attitude of public health authorities on preserva- 
tion of milk by heat. Med. Rec, Sept. 7. 

Registrar-General of England and Wales. 1907. Sixty-eighth annual report of 
births, deaths, and marriages. (1905.) London. 

Reid, George. 1906. Infantile mortality and the employment of married women 
in factory labor before and after confinement. Lancet, Aug. 18. London. 

Rew, R. H. 1907. Milk supply of London. Lancet, Apr. 20, p. 1116. London. 

Sandilands, J. E. 1906. Epidemic diarrhea and bacterial content of food. 
Journ. Hyg., Jan. 

Schroeder, E. C, and Cotton, W. E. 1906. The relation of tuberculous lesions 
to the mode of infection. IJ. S'. Dept. of Agriculture, Bureau Animal In- 
dustry, Bull. No. 93. Washington. 

Stewart, A. H. 1906. Digest of medical literature. Milk from a sanitary 
standpoint. Am. Med., Feb. 17, p. 253. 

Walsham, Hugh, 1905. The channels of infection in tuberculosis, New York. 



9. ICE CREAM. 



(249) 



ICE CREAM. 



By Harvey W. Wiley, M. D., Ph. D., 
Chief of Bureau of Chemistry, Department of Agriculture. 



The use of artificially frozen dishes as an article of diet is not of 
very ancient origin. It is not the purpose of this paper to discuss 
the physiological and dietetic effects of introducing ice-cold foods into 
the stomach. There are grave objections to the practice which will 
occur to every physiologist and hygienist. Briefly I may state that 
the process of digestion in the stomach depends upon the free excre- 
tion of the peptic ferments by the glands of the inner coats of the 
stomach. The introduction of large quantities of ice-cold material 
can not fail to contract the orifices of these glands and check their 
excretory activity. 

Aside from this, however, the question of ice cream is one of grave 
importance in connection with the dairy supplies of the country, 
and particularly so because under the name of ice cream are found 
upon the markets products of the widest variation in composition, 
varying from the true ice cream to the true frozen pudding. 

It is necessary, therefore, in the discussion of the matter, if possi- 
ble, to ascertain first, what ice cream is or should be, and second, to 
study the materials from which it is made with a view to determining 
their sanitary character, and finally to determine the composition of 
the article itself as it is offered to the market. Incidentally there- 
fore the dairy which furnishes the milk and the milk which furnishes 
the cream are subjects of inquiry. These two subjects, however, have 
been carefully gone over in other papers of this series and hence any 
reference to them will be merely of an incidental character as illus- 
trating some point in connection with the particular subject at hand. 

The term " ice cream " is used in this country to cover a large 
variety of products, which in Europe are known under the general 
term of " ices." The Neapolitan ices are said to be a type of the 
European dishes. This type of ices is found in most of the cities of 
Europe, served often in very attractive packages with various adorn- 
ments or used directly without molding upon the table. The art of 
representing different kinds of fruits and flowers, animals, and other 

(251) 



252 

objects is also said to be of distinct European origin, although copied 
very largely in this country. For this reason there may be seen in 
both countries frozen products representing fruits of every descrip- 
tion and usually colored and flavored to imitate the fruits which they 
represent. Strawberries, apples, pears, lemons, oranges, pineapples, 
peaches, apricots, bananas, grapes, and nearly all other fruits are thus 
represented. Various figures of statuary, or public buildings, or ob- 
jects of art are also imitated in the form of frozen packages of this 
description. Even when milk or cream is used in the composition of 
these frozen dainties in Europe it is not the custom to call them ice 
cream. The Italian general name for these dishes is " sorbetto," the 
German is " Gefrorenes," the French " glace," and the English " ice." 
With the exception of the frozen dish called " sherbet," practically 
all the forms known in Europe under the names given are called, or 
have been called until recently in this country, " ice cream." 

In the discussion of this problem I shall first offer the investigations 
made under the auspices of the committee appointed by the District 
Commissioners to advise them in regard to the dairy products on 
sale in the District, including a study of the raw material from which 
ice cream is made and of the ice creams themselves. These studies 
have been conducted both from the chemical and bacteriological points 
of view. 

I will afterwards give a brief historical sketch of the use of the 
term ice cream and the compounds to which it has been applied. 

Next will be presented certain data respecting a proper standard 
for ice cream, a standard adopted by the United States Department 
of Agriculture under authority of an act of Congress, and the criti- 
cisms of this standard made by manufacturers and dealers in ice 
cream. 

In this way it is believed that the whole subject may be presented 
in such form as to be useful not only to the Commissioners of the 
District in any work which they may inaugurate respecting the con- 
trol of ice cream, but also to the people of the District and the people 
of the country in general. 

It is not deemed advisable to go into minute details respecting the 
bacteriological and chemical investigations. I will content myself 
therefore with presenting the tables of analytical data and with giv- 
ing a summary of the chemical and bacteriological investigations. 

SUMMARY OF CHEMICAL DATA RELATING: TO CREAM. 

The samples of cream which were purchased in the open market 
covered a period extending from January 30, 1907, to June 12, 1907, 
inclusive. (See Table III, page 300.) 

For the purpose of this investigation the analytical data reported 
referred only to the percentage of fat in the cream and to its artificial 



253 

coloring. The analyses were made in the dairy laboratory by and 
under the supervision of Mr. G. E. Patrick. 

The total number of samples examined is 132, including one double 
cream excluded from the averages. The average percentage of fat 
therein is 19.09. 

By act of Congress the legal standard of fat in cream for the 
District of Columbia is 20 per cent. The number of samples at or 
above 20 per cent is 44, or 33.58 per cent. The number of samples 
below 20 per cent of fat is 87, or 66.41 per cent. 

These data show that only one-third of the samples of cream pur- 
chased complied with the legal standard for the District. The 
standard for fat in cream, established by the Secretary of Agriculture 
under authority of Congress for the country at large in so far as 
interstate commerce is concerned is 18 per cent. The number of 
samples examined which are found at or above 18 per cent is 82, 
equivalent to 62.60 per cent of the total number. The number of 
samples below 18 per cent is 49, or 37.4 per cent of the whole number. 

The data show that as sold upon the markets of Washington during 
the time mentioned almost two-thirds of the commercial creams com- 
plied with the national standard. The total number of samples of 
the above lot which are found to contain more than 25 per cent of fat 
is 6 ; the number of samples containing less than 16 per cent is 24 ; the 
number of samples containing less than 14 per cent is 6, and the num- 
ber containing less than 13 per cent is 3, all of which are from the 
same dairy. These data show that the requirement of 18 per cent of 
fat, judged by the ordinary commercial data, is entirely just and sat- 
isfactory. Hence it follows that ice cream made from standard cream 
will easily contain 14 per cent or more of butter fat for the vanilla 
type of ice cream, and 12 or more per cent for the fruit type of ice 
cream, thus showing that the standards established are reasonable 
and just from the commercial conditions which actually exist. Of 
the total number of samples examined 15, equivalent to 11.45 per cent, 
are found to be artificially colored, thus showing that the artificial 
coloring of cream is not practiced to any great extent, and its entire 
prohibition would not in any way disturb the existing conditions of 
trade. 

SUMMARY OF THE CHEMICAL DATA RELATING TO ICE CREAM. 

The chemical analyses of the ice creams were made in the dairy 
laboratory of the Bureau of Chemistry by and under the supervision 
of Mr. G. E. Patrick, chief of that laboratory. (See Table IV, 
page 303.) 

For the purpose of this report only the fat content of the various 
samples of ice cream, the presence of gelatin, vegetable thickeners, and 



254 

coal-tar dyes are reported. The summary of the chemical data show 
the total number of samples analyzed to be 228. Judged by the stand- 
ard of 14 per cent for the ice creams of the vanilla type and 12 per 
cent of fat for the ice creams of the fruit type, it is found that there 
are at or above standard 117 samples, or 51.32 per cent, and below 
standard 111 samples, or 48.68 per cent. The average percentage of 
fat in the entire 228 samples is 12.67. Only 46, or 20.18 per cent of 
the whole number of samples, contain less than 10 per cent of fat, and 
only 25, or 10.97 per cent, contain less than 8 per cent. 

The total number of samples containing a thickener was 80, or 35.18 
per cent. In 33 samples, or 14.47 per cent, the thickener is gelatin, 
while in 47 samples, or 20.61 per cent, the thickener is a vegetable gum 
or starch. Only 2 samples are found to contain coal-tar dye. 

These samples were purchased at random from all the principal ice 
cream makers in Washington, over a period extending from about 
April 1 to August 1, 1907. 

The data are most interesting in view of the contention that the 
standard suggested for butter fat is too high, and especially in view 
of the fact that 8 per cent has been suggested by many as a proper 
standard. The chemical examination shows how devoid of commer- 
cial significance are both of the claims mentioned. Another interest- 
ing fact is that the percentage of samples containing gelatin is 
extremely small. This is of great significance as being a most 
emphatic negative answer to the contention that gelatin is necessary 
to the manufacture of ice cream, or is generally employed. The 
chemical data on the whole give no support to the contention that the 
suggested standard for ice cream is unfair. The absence of eggs, 
gelatin, starch, and other substances, which it has been said are com- 
monly used in the manufacture of ice cream, from the great majority 
of the samples is another point of great significance. In fact, the data 
show most conclusively that the term ice cream, even from a commer- 
cial point of view, is applied to a substance containing more than 14 
per cent of fat in more than 51 per cent of all the samples examined. 
It is, therefore, commercially as well as scientifically and hygienically, 
a term which should be applied to a substance of standard composi- 
tion and that standard, in so far as Washington is concerned, could 
be reached with but little variation from the usual methods of pro- 
ducing ice cream. What is true of Washington certainly should be 
true of other cities, since there is no indication that the quality of the 
creams made in Washington is any better than that of other cities. 

The only conclusion which can be derived from the study of these 
chemical data is that the term ice cream should apply generally, as 
it does in the majority of cases at the present time as indicated by 



255 

the results of these investigations, to a product made principally of 
cream and sugar, and with a natural flavor, either of an ordinary 
flavoring substance like vanilla or of fruit. Hence there appears to be 
no reason for departing from the established standard, in view of the 
data which have been secured by an examination of the commercial 
samples bought in the open market from all portions of the city. 

BACTERIOLOGICAL INVESTIGATIONS OF ICE CREAM IN THE DIS- 
TRICT OF COLUMBIA. 

[Made by or under the direction of Dr. George W. Stiles, and by or under the direction of 

Dr. M. E. Pennington.] 

In most instances the samples of ice cream received for examination 
were collected directly from the original place of manufacture. In a 
few cases, however, miscellaneous samples were taken at places other 
than those at which the product was prepared. Generally half a 
pint or a 10-cent box furnished a sufficient quantity to make the 
chemical, microscopical, and bacteriological examinations. The 10- 
cent box, to which reference is made, was the pasteboard carton 
almost universally used as a container for ice cream when sold in 
small quantities, and for this reason it was much preferred as a 
carrier of the samples to be investigated. When these cartons were 
not available well-cleansed bottles or new paper boxes were used 
instead. 

Upon arriving at the laboratory, samples for bacteriological ex- 
amination were removed at once from the frozen interior by means of 
sterile spoons and placed in sterile dishes to melt. Generally within 
eight to ten minutes a sufficient liquefaction had occurred to enable 
the experimenter to remove enough material to make the bacteriolog- 
ical examination. 

The enormous number of organisms which are found in cream, 
milk, and ice cream, necessitates high dilutions to make possible the 
quantitative determination of the organisms present. For the mak- 
ing of these, and the counting of the colonies Avhich developed, the 
technique pursued may be stated briefly as follows: The quantities 
were measured in 1 cubic centimeter pipettes, graduated in 0.01 
of a cubic centimeter, and 10 cubic centimeter pipettes graduated 
in 0.1 of a cubic centimeter. They were sterilized by heat and kept 
in bacteria-proof metal cases. 

In order to make the necessary dilutions Erlenmeyer flasks of about 
500 cubic centimeters and 100 cubic centimeters capacity, respectively, 
were used. To the former were added 99 cubic centimeters of sterile 
water and to the latter 9 cubic centimeters. To the flask containing 
99 cubic centimeters there was added 1 cubic centimeter of the sample 



256 

to be examined, thus making a dilution of 1 to 100. From it 1 cubic 
centimeter was removed and added to the second flask containing 9 
cubic centimeters, making a second dilution of 1 to 1,000. By a con- 
tinuance of this method, namely, the removal of 1 cubic centimeter 
and its addition to the fresh flask containing 9 cubic centimeters of 
pure water, the dilutions may be run as high as desired. For the 
routine of this work dilutions of 1 to 1,000; 1 to 10,000; 1 to 100,000, 
and 1 to 1,000,000, were adopted. 

The sowing of the organisms on the nutrient jelly was made by the 
removal of 1 cubic centimeter from the flask containing the desired 
dilution and its transference to a sterile petri plate, into which was 
immediately poured the melted medium and the organisms evenly 
distributed by shaking with a rotary motion. Duplicate plates were 
made in all cases and 2 per cent lactose agar was selected as the 
nutrient medium affording most satisfactory results. All the plates 
for this investigation were grown at a temperature of 30° C. for a 
period of three days, after which the colonies when numerous were 
counted by means of a Stewart counting chamber or when but few 
by the naked eye alone. 

The presence of gas-producing organisms was determined in this 
investigation by adding 1 cubic centimeter of the 1 to 100 dilution to 
sterilized 2 per cent dextrose fermentation tubes and incubating at 
30° C. for three days. When gas formation took place the quantity 
was estimated by the ruled scale method, as described by Frost in his 
Laboratory Manual. 

An endeavor was made to determine systematically the presence 
and approximate number of streptococci in each sample of ice cream, 
cream and milk, which has been examined recently by this Depart- 
ment. For this purpose 15 cubic centimeters were centrifugalized 
with an electric centrifuge for a period of fifteen to twenty minutes, 
and from the sediment were made several smears which were stained 
with methylene blue. Such a procedure yielded results with milk and 
cream alone, but when in the form of ice cream, especially those with 
fruit or chocolate flavors, the debris seemed to interfere to such an 
extent that satisfactory results were not always obtained. With the 
vanilla flavors the results were better, but even in such cases they were 
exceedingly rough. Hence there are a number of blanks in the tables 
and summaries of this work dealing with the presence in ice cream of 
streptococci, and the determination of the number of leucocytes per 
cubic centimeter in ice cream was made in but a few cases. 

Between October 13, 1906, and July 29, 1907, 263 samples of ice 
cream, collected in the City of Washington, were investigated as above 
outlined. That the bacterial flora in the majority of these ice creams 



257 

was numerically enormous may be gleaned from the following sum- 
mary : 

Samples showing — 

Less than 10,000 organisms per cubic centimeter 

From 10,000 to 50,000 organisms per cubic centimeter 

From 50,000 to 100,000 organisms per cubic centimeter 

From 100,000 to 250,000 organisms per cubic centimeter 2 

From 250,000 to 500,000 organisms per cubic centimeter 3 

From 500,000 to 1,000,000 organisms per cubic centimeter 14 

From 1,000,000 to 2,000,000 organisms per cubic centimeter 23 

From 2,000,000 to 5,000,000 organisms per cubic centimeter 34 

From 5,000,000 to 10,000,000 organisms per cubic centimeter 50 

From 10,000,000 to 25,000,000 organisms per cubic centimeter 64 

From 25,000,000 to 50,000,000 organisms per cubic centimeter 42 

From 50,000,000 to 100,000,000 organisms per cubic centimeter 15 

Above 100,000,000 organisms per cubic centimeter 16 

A study of the individual results from which the above summary 
was made shows that the average number of organisms per cubic cen- 
timeter is 26,612,371. The maximum count obtained was 365,000,000, 
the minimum 137,500 per cubic centimeter. Of the total number of 
samples, 71.1 per cent showed the presence of gas-producing organ- 
isms when 2 per cent dextrose fermentation tubes were inoculated 
with 0.01 cubic centimeter of the sample. 

Reports on the presence or absence of streptococci have been made 
on 115 of the above samples; 38.3 per cent of this number showed the 
presence of the organism, and 61.7 per cent of the samples examined 
failed to show it when tested by the method above described. 

During the course of this investigation 53 manufactories of ice 
cream in Washington, large and small, have been visited in order to 
determine the sanitary conditions prevailing where this food product 
is manufactured. In 62.2 per cent of these places the ice cream is 
made in the basement or cellar. In nearly all cases they are improp- 
erly constructed to meet the demand of sanitary conditions. The ceil- 
ings are low and generally show a gross collection of filth and cob- 
webs on the rough joints overhead. Occasionally a cellar is finished 
Avith a metal ceiling or plaster, but even when such improvements are 
noticed the absence of natural proper light or ventilation generally 
makes the cellar basement in Washington an unfit place for the man- 
ufacture or preparation of ice cream. Many of the buildings are of 
old-time construction and were not originally designed for the pres- 
ent-day purposes. With such construction as they show it is practi- 
cally impossible to keep the average basement or cellar in a proper 
and fit condition for the handling of milk, cream, and milk products, 
no matter how honest and thorough may be the attempts of the 
tenants to do so. , 

45276°— Bull. 56—12 17 



258 



In many cases the tenants have much to contend with and report 
that their landlords are wholly unwilling to make alterations or neces- 
sary improvements, and if such are made it must be done entirely at 
the expense of the tenant. Sometimes, however, the fault does not lie 
exclusively with the landlord. Very frequently the basement in these 
establishments is used not only for the manufacture of ice cream and 
frozen dainties but also as a storage room for all the old waste which 
may have accumulated for years past — old broken furniture, scraps of 
metal, cast-off clothing, broken boxes, barrels, moth-eaten rugs, mat- 
ting — in fact one may find just such worthless stuff as generally col- 
lects about the dwelling house in the course of time. Such articles 
must of course pollute, and most dangerously, any food products 
which are brought into their proximity, and the nature of the bac- 
terial flora found in the foodstuffs manufactured in these insanitary 
surroundings fully bear out the truth of the above statement. 

While the premises are themselves of insanitary construction an 
immense benefit would accrue to the consumers of ice creams, char- 
lotte russes, cream puffs, custards, etc., if a general house cleaning on 
the part of the tenants were demanded and enforced. 

An analysis of the individual findings in the 53 places visited and 
the classification, so far as possible, on the basis of " clean, dirty, fair, 
and filthy " shows the following results : 



Clean. 


Fair. 


Dirty. 


Filthy. 


3 
«5.6 


16 
a 30.1 


19 
a 35. 8 


9 
a 16. 9 



a Per cent . 

While undoubtedly the insanitary conditions prevailing in and 
about the ice cream manufactories of Washington must influence the 
wholesomeness of the product from the bacteriological point of view, 
it is not entirely responsible for the great number of organisms which 
are ordinarily found in such foods. As previously stated, the cream 
and milk supply of the city has been investigated by the Bureau of 
Chemistry, and although the detailed results will not be reported here, 
it is advisable to consider briefly the findings of the bacteriological 
examination of 130 samples of cream collected in the city of Wash- 
ington from February 1 to July 27, 1907. 

Samples showing — 

Less than 10,000 organisms per cubic centimeter 

From 10,000 to 50,000 organisms per cubic centimeter 3 

From 50,000 to 100,000 organisms per cubic centimeter 6 

From 100,000 to 250,000 organisms per cubic centimeter 20 

From 250,000 to 500,000 organisms per cubic centimeter 19 

From 500,000 to 1,000,000 organisms per cubic centimeter 15 



259 

Samples showing — 

From 1,000,000 to 2,000,000 organisms per cubic centimeter 13 

From 2,000,000 to 5,000,000 organisms per cubic centimeter 11 

From 5,000,000 to 10,000,000 organisms per cubic centimeter 10 

From 10,000,000 to 25,000,000 organisms per cubic centimeter 11 

From 25,000,000 to 50,000,000 organisms per cubic centimeter 10 

From 50,000,000 to 100,000,000 organisms per cubic centimeter 7 

100,000,000 or above organisms per cubic centimeter 2 

The preceding summary indicates but too plainly the source of the 
majority of the organisms in ice cream. Not a single sample showed 
less than 10,000 organisms per cubic centimeter and only 3 Avere less 
than 50,000, while 14, or 10.8 per cent, were between 10,000,000 and 
25,000,000. The average number of organisms for all the samples 
examined was 12,130,080 per cubic centimeter. The maximum count 
was 309,000,000 and the minimum was 12,000 per cubic centimeter. 
An examination of these creams for the presence of fermenting or- 
ganisms showed that when 2 per cent dextrose fermentation tubes 
were inoculated with 0.01 cubic centimeter 51.53 per cent of the 
samples developed gas. 

Between January 12 and July 2, 1907, a bacteriological examina- 
tion was made of 381 samples of milk collected in the city of 
Washington. The quantitative bacteriological findings are appended : 

Samples showing — 

Less than 10,000 organisms per cubic centimeter 12 

From 10,000 to 50,000 organisms per cubic centimeter 59 

From 50,000 to 100,000 organisms per cubic centimeter 65 

From 100,000 to 250,000 organisms per cubic centimeter 70 

From 250,000 to 500,000 organisms per cubic centimeter 40 

From 500,000 to 1,000,000 organisms per cubic centimeter 23 

From 1,000,000 to 2,000,000 organisms per cubic centimeter 25 

From 2,000,000 to 5,000,000 organisms per cubic centimeter 38 

From 5,000,000 to 25,000,000 organisms per cubic centimeter 26 

From 10,000,000 to 50,000,000 organisms per cubic centimeter 13 

From 25,000,000 to 100,000,000 organisms per cubic centimeter 4 

From 50,000,000 to 100,000,000 organisms per cubic centimeter 2 

Above 100,000,000 organisms per cubic centimeter 2 

It was found that the average number of organisms per cubic cen- 
timeter was 3,415,533, with a maximum count of 283,000,000 per cubic 
centimeter and a minimum of 1,000. It is of interest to note, however, 
that only 12 of the 381 samples showed a bacterial count of less than 
10,000. Thirty-seven per cent of the samples showed the presence of 
gas-producing organisms when tested according to the method 
previously given. 

The foregoing investigations would seem to clearly demonstrate 
that so far as the ice cream supply of the city of Washington is con- 
cerned there is, bacterially, a wide field for its betterment, beginning 
with the cream and milk which enter into its composition and pro- 



260 

gressing steadily through every step of its manufacture to the final 
cleansing of the hands and garments of the employees who dispense 
this easily polluted foodstuff. 

Unfortunately for the good of the country at large, and judging 
from a cursory knowledge of ice cream manufactories in general and 
the reported findings of milk and cream supplies throughout the 
country, the conditions prevailing in Washington can not be 
accepted as unique. 

A study of the commercial ice cream of Philadelphia was made in 
the Bacteriological Laboratory of the city during 1905-6. (Bacterio- 
logical Study of Commercial Ice Cream, Pennington and Walter, 
New York Medical Journal, Vol. LXXXVI, No. 22, page 1013.) The 
examination in Philadelphia covered the number of organisms pres- 
ent, an approximate count of the leucocytes, the presence of strep- 
tococci morphologically and the determination of their vegetative 
ability, the sanitary condition of the premises on which the ice cream 
was manufactured, the sanitary condition of the shop or dealer's 
warehouse from which the cream and milk were obtained, and the 
bacteriological examination both numerically and for the presence of 
living streptococci in the cream and milk which entered into the 
sample of ice cream studied. 

In so far as the cleanliness of the premises and the product is con- 
cerned the above authors make the following statements: 

Sixty different ice cream makers were visited and their premises inspected. 
What constitutes a standard of cleanliness in the production of such food- 
stuff as ice cream depends very largely upon the inspector's ideas on the sub- 
ject. The very nature of the process — the mixture of ice and salt, wooden tubs 
for freezing, fruit flavoring, etc. — makes it a difficult matter to preserve immac- 
ulate surroundings even when interiors of utensils and constituents of the ice 
creams are strictly clean. The final division of these 60 different makers' estab- 
lishments was made on the basis of four classes: (1) Clean; (2) fair; (3) 
dirty; (4) filthy. In rating them the building, drainage, opportunities for 
ventilation, conditions of walls, ceilings, windows, adjoining rooms or buildings, 
as well as the condition of the utensils, methods of cleaning, attempts at sterili- 
zation, etc., were taken into account. The results are as indicated. 

Division of 60 different establishments. 



Condition. 





Percent- 


Number 


age hav- 


of estab- 


ing strep- 


lish- 


tococci 


ments. 


in ace 




cream. 


20 


90 


26 


77 


6 


66 


8 


75 



Average 

count of 

organisms 

per cubic 

centimeter. 



Clean 
Fair.. 
Dirty. 

Filthy 



12, 460, 863 
15,857,800 
22,491,833 
29,225,714 



261 

The maximum number of organisms found was 151,200,000 per cubic centi- 
meter and the minimum was 50,000 per cubic centimeter. 

While the cleanliness of the manufactory does not, according to this inves- 
tigation, bear any constant relation to the presence of streptococci it does affect 
the cleanliness of the finished product as indicated by the total bacterial con- 
tent, a gradual rise being observed from the " clean " shops to the " filthy " ones. 
The latter were sometimes almost beyond description. For instance, sample 42 
was made in a shed adjoining both a dwelling and a stable for 8 or 10 horses. 
The workmen went from horses and stable cleaning to the ice cream shed with- 
out restraint, handling the utensils in the latter as necessity demanded, re- 
gardless of soiled clothes or hands. Ice cream cans and milk cans stood in a 
passageway common to both shop and ice cream manufactory, a part of which 
was bordered on each side by stalls for horses. The stench of this place finally 
caused complaint from the neighborhood and it was dealt with on the ground of 
a nuisance. On the other hand a large ice cream manufacturer had endeavored 
to preserve the strictest cleanliness possible. Employees engaged in ice cream 
making did no other work and each man had only certain duties or portions of 
the process assigned to him. He changed his clothing and took a bath when be- 
ginning the day's work and clean lockers and plentiful showers were provided 
to enable the fulfillment of this regulation. The utensils were cleaned with 
soda and finally placed on a steam table for sterilization. Such precautions 
resulted in the counts given in samples 27 and 48 and 49, namely, 6,535,000, 
33,120,000, and 20,550,000. 

Through the courtesy and interest of the head of this ice cream firm a bacte- 
riological study of each step in the process was made possible. The cream in 
the supply tank was first sampled, a portion was then drawn off by the employee, 
mixed with the necessary sugar (cane) for sweetening, and a sample of this 
taken for examination. After adding the vanilla and transferring to the freez- 
ing cans it was again sampled, and then the frozen product was also examined. 
In the freezing the bulk a little more than doubled. Although frozen the ice 
cream was soft enough to measure in a wide-mouthed 10 cubic centimeter pi- 
pette, and it was plated, after appropriate dilution, at once. The results of the 
frozen cream, to be comparable with those of the preceding samples, should, 
therefore, be about doubled. The plates were of agar and were grown at 20° C. 

Organisms in ice cream at each step in the process of making. 



Articles. 



On agar at 
20° C, or- 
ganisms 
per cubic 
centimeter. 



Streptococci. 



Cream from tank 

Cream and sugar , 

Cream, sugar and vanilla in freezer 
Frozen cream 



2,840,000 

7,000,000 

5, 750, 000 

a 2, 250, 000 



Present, about 25 per cent of all or- 
ganisms and in an active condition. 



a Multiplied by 2 equals 4,500,000. 

It is of interest to note in the examination of the above sample 
of ice cream that a careful pasteurization had been performed by 
the ice-cream maker immediately upon the receipt of the cream. 

The presence of streptococci in the ice cream on sale in the city of 
Philadelphia has been made the subject of special study in the article 



262 

to which reference has been made. The summary of the results states 
that — 

In 55 out of the 68 samples, or 80 per cent, streptococci were found. 

In 45 examinations, or 66 per cent, not only the finished product, but the 
milk or cream used in its manufacture were investigated. In 35 of the 45 
cases, or 77 per cent, streptococci were found in the milk or cream and in the 
ice cream as well. From 23, or 33 per cent of all examined, the streptococci 
were isolated in pure culture. They grew fairly easily. In only 3 samples 
were these organisms found in the cream alone, and where both cream and ice 
cream were examined only twice in the ice cream alone. The question of the 
original source of streptococci in ice cream is of importance from a sanitary 
standpoint. The conditions under which the mixtures are made and frozen, 
the cleansing of the utensils, etc., are such that very often almost any kind of 
bacterial infection may gain access to it. 

The usual source of streptococci in milk or cream, however, is the cow, and, 
judging from the results set forth here, it is the cream or milk entering into 
the ice cream which is the carrier of the germs. The cleanliness of the sur- 
roundings under which the ice cream is made does not seem to greatly affect 
the presence of streptococci. 

Since ice cream is a food which is so largely used by children and 
invalids whose digestive tracts are more readily open to bacterial 
infection than are those of the adult or the person in perfect health, 
the widespread presence of an organism to which so much responsi- 
bility for ill-doing is attached as appertains to the streptococcus, 
should be looked upon with suspicion and every care possible taken to 
exclude it from such food products — at least until it has been proven 
innocuous. 

There seems to be a certain class of adults who have a predispo- 
sition against ice cream and who can not ingest it without a feeling 
of discomfort and in not a few cases symptoms of severe toxic 
poisoning result, manifesting the usual course of nausea, vomiting, 
diarrhea and pains in the abdomen, with cramps and muscular 
pains, often followed for a short time by general weakness, malaise, 
loss of appetite, and headache. Where samples of ice cream asso- 
ciated with such disturbances have been examined bacteriologically 
they have often shown the presence of overwhelming numbers of 
streptococci, constituting practically a pure culture, or associated 
with organisms such as B. coli or other bacteria known to be found 
under insanitary conditions. 

Where in the routine examination of a city's milk supply the absence 
or presence of streptococci is made the subject of investigation, it has 
been found that approximately 40 per cent of the milk offered com- 
mercially contains these organisms, and in the cases of certain indi- 
vidual cities the results are much higher. According to the inves- 
tigations, already quoted by Pennington & Walter, 80 per cent of 
commercial ice cream contains these organisms. In an endeavor to 



263 

determine the reason for this high frequency, they conducted a study 
on the relative rate of growth of streptococci isolated from milk, 
in milk and cream, and find that there is a much more rapid pro- 
liferation of the organism in cream than in milk. The difference in 
the relative rate of growth is more striking, also, at the temperature 
of the refrigerator (about 12° C.) than at higher temperatures, 
which may account, at least to some extent, for the frequency with 
which this organism occurs in ice cream and also for its overwhelm- 
ing proportion there. 

It was noticed also that the thickening of cream, inoculated with 
pure cultures of streptococci and kept cool, was very marked. Its 
whipping quality greatly increased and the separation of a curd was 
extremely slow, all of which qualities are sought after by the ice- 
cream maker. 

CHANGES IN ICE CREAM DURING STORAGE. 

An important point to be considered in the study of ice cream is 
the change which takes place during the storage thereof. It is quite 
customary at the present time to make a kind of ice cream which is 
intended to be kept a long while and shipped to great distances. 
It is generally supposed that very low temperatures entirely in- 
hibit bacterial growth. That this is not always the case is shown 
by the results of the investigations which are appended. In order 
that some definite knowledge might be obtained of what actually 
takes place respecting the bacterial flora during cold storage two sets 
of investigations were instituted — one in Washington under the 
supervision of Dr. George W. Stiles, and one in Philadelphia under 
the direction of Dr. M. E. Pennington. Doctor Stiles's report is as 
follows : 

The technique used in the study of ice-cream samples kept in a frozen con- 
dition for about thirty days corresponded very closely to that used in the 
quantitative examination of the ice-cream samples heretofore described. The 
sampling, however, was of necessity somewhat modified. 

From each of four representative dealers twelve 5-cent samples were pur- 
chased, each sample being kept separate in a 5-cent paper carton, as used by 
such dealers. One dealer, however, not having the small cartons at hand 
wrapped the samples each in tissue paper and placed all of them within a new 
pasteboard box. The samples were kept in a cold-storage warehouse where the 
temperature varied from 0° to 10° above F. The graphic chart shows the 
variations in bacterial content of these four groups of samples. 

In addition to making counts of the number of organisms present, each sample 
was tested for gas-producing organisms, and from each a bacillus was isolated 
which belonged to the B. coli group. 

The initial count of sample No. 1 was 16,000,000; of No. 2, 85,000,000; of 
No. 3, 135,000,000, and of No. 4, 53,000,000. The variation from these numbers 
during the keeping of the sample will be noted in the table which follows, as 



264 

well as the decrease of gas production in some and no noticeable difference in 
others, especially No. 1, which showed gas-producing bacteria during the entire 



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period. With a decrease in the gas-producing bacteria after the first or second 
week there was also noted a marked decrease in the number of organisms, 
though in many cases these again increase. 



265 

Table showing the number of organisms and percentage of gas production in cold-storage 

ice cream. 



Group 
No. 


Serial number of sample. 


Days in 
storage. 


Bacteria per 
cubic centi- 
meter. 


Percent- 
age of 
gas. 


Percent- 
age of 
gas, du- 
plicate. 




[401 




3 

6 

9 

11 

14 

17 

20 

23 

27 

30 

34 



3 

6 

9 

11 

14 

17 

20 

23 

27 

30 

34 



3 

6 

9 

11 

14 

17 

20 

23 

27 

30 

34 



3 

6 

9 

11 

14 

17 

20 

23 

27 

30 

34 


16,000,000 

25, 000, 000 

21,000,000 

27,000,000 

18, 000, 000 

3, 000, COO 

6,000,000 

13, 000, 000 

20, 000, 000 

185, 000, 000 

8,000,000 

3, 000, 000 

85, 000, 000 

175,000,000 

38,000,000 

48, 000, 000 

18,000,000 

9, 000, 000 

9, 000, 000 

70, 000, 000 

19, 000, 000 

125, 000, 000 

10, 000, 000 

11, 000, 000 

135, 000, 000 

195, 000, 000 

138, 000, 000 

145, 000, 000 

115, 000, 000 

39,000,000 

35, 000, 000 

93, 000, 000 

97, 000, 000 

385, 000, 000 

50,000,000 

28, 000, 000 

53,000,000 

95, 000, 000 

47,000,000 

75,000,000 

54, 000, 000 

7, 000, 000 

27, 000, 000 

95,000,000 

49, 000, 000 

205, 000, 000 

30,000,000 

9,000,000 


25 
45 
30 
20 
25 
25 
30 
30 
20 
20 
15 
20 
25 

5 


30 











A 




25 
30 
20 
30 
40 

2 

9 

1 

5 

18 
18 


25 
18 
25 
10 
15 

1 

9 



1 

5 


12 


25 




429 


35 




V 

433 


30 




440 


30 




484 


25 




489 


20 


1 


542 


35 




538 


25 




546 


25 




555 


20 




564 


10 




568 


20 




(404 


25 




430 


5 




434 







441 







485 












2 




543 







539 







547 







556 







565 







569 







(403 : 


25 






20 




435 


30 




442 


40 




486 


25 




491 


8 


o 

3 


544 


10 




540 







548 


5 




557 







566 














f 402 


10 




432 


20 




436 


15 




443 


20 




487 


1 




492 





4 


545 


20 




541 







549 







558 







567 







571 


o 









266 

The experiment conducted under the direction of Doctor Penning- 
ton follows: 

While the temperature of 0° C. is ordinarily accepted as that at which bac- 
terial life is either quiescent or annihilated, the making of ice cream in a freez- 
ing mixture of ice and salt reduces the substances to a temperature of from 
— 10° C. to — 20° C. To test the action of this temperature on the very rich 
bacterial flora ordinarily occuring in commercial ice creams, samples were 
obtained from various sources and maintained for several days at a tem- 
perature varying at from — 10° C. to — 20° C. It has been found by inquiry and 
observation that ice cream may be kept by a manufactory or more likely by 
the retail dealer for a week or ten days. It is of course kept for greater 
lengths of time when provisioning ocean liners or stored for some particular 
purpose, but this is rather the exception. It was deemed advisable, therefore, 
to limit this preliminary investigation to the period which is ordinarily that 
of commerce. 

The samples of ice cream tested were purchased in open market or sent 
directly from the manufacturer, who had no knowledge of the purpose for 
which they were intended. When coming from the manufacturer they were 
packed in the usual tin ice-cream storage can, set in an ice and salt mixture. 
When purchased from restaurants, confectioners, etc., the sample was obtained 
in a sterile wide-mouthed glass jar, tightly capped, and was immediately 
packed down in ice and salt. All the samples to facilitate keeping were placed 
in a room in the cold-storage warehouse, where the temperature was slightly 
below freezing. Here they were inspected daily, ice and salt added as required, 
and samples for study removed with sterile glass spatulas. 

For the determination of the total number of organisms, approximately 
1 cubic centimeter of the cream, which was melted as promptly as possible 
after reaching the laboratory, was weighed in a tared, sterile weighing bottle, 
made up to 10 cubic centimeters with sterile water, and from this mixture 
were prepared appropriate dilutions for the counting of organisms. 

The plating was done on litmus lactose agar, half the plates of each sample 
being allowed to develop colonies at a temperature of 37° C, and the other 
half placed in the refrigerator, running from 18° C. to 20° C. It has been 
found necessary to use both these temperatures if an accurate idea is to be 
obtained of the changes undergone by organisms when submitted to continuous 
low temperatures, since there is apparently a dying off of certain groups of 
organisms in the early stages of storage, and the gradual increase of other 
organisms, which seem ultimately to thrive under what are usually conditions 
fatal to growth. 

The results obtained in the study of 8 samples of ice cream are tabulated 
as Series I, II, and III, of Table I. Series I extended over sixty-six hours; 
Seres II covered a total of one hundred and ninety-two hours, and Series III a 
total of two hundred and sixteen hours. 

As with all experiments where the bacterial flora is of as varied a character 
as that found in commercial cream, there is observed in this work a consid- 
erable variation in the behavior of different samples. Generally the tendency 
is to show a decrease for at least several days in a number of organisms 
developing at body heat, though occasionally these organisms persist and thrive 
at low temperatures. The organisms, developing at the temperature of the 
refrigerator show usually a period of decrease which may last several days, to 
be followed later by a very pronounced rise. Sometimes the killing off of the 
organisms is very slight, their numbers remaining almost stationary or making 
a continuous upward curve. 



267 



The experiments cited are too few to permit of formulating definite conclu- 
sions and it must not be forgotten that, purchased as they were — in open! 
market— their histories unknown, there may have occurred a considerable part 
of the bacteriological cycle before the specimens were investigated. The results 
given simply show what may happen to commercial ice cream if kept for from 
three to ten days. 

Two experiments have been made to test the action of freezing and thawing. 
For this work cream was obtained from a milk dealer, sweetened and flavored 
with vanilla in the laboratory, and frozen in a small hand freezer, which had 
been cleansed simply with hot water. After freezing the product was packed 
down in an ice-salt mixture ami allowed to stand until the cream had thor- 
oughly melted, though the temperature was still considerably below that of the 
surrounding atmosphere. It was then refrozen and again allowed to stand for 
some hours. At each step the bacterial count was made and recorded, as seen 
in Table II. Experiments of this character are of interest, not only for the trac- 
ing of decrease in numbers, but also as a possible source of information regard- 
ing the many cases of ice-cream poisoning blamed upon stale ice cream, and 
particularly that which had been melted and refrozen. 

Table I. — Growth of bacteria in ice cream at the temperature of ice and salt 
{-n°C. = -5.8°F.). 

SERIES I. 



Source of ice cream. 



Total number of organisms in- 



1 gram of 
fresh ice 
cream. 



1 gram after 
18 hours. 



1 gram after 
42 hours. 



1 gram after 
66 hours. 



No. 1— Manufacturer, sample sent directly 
from factory, 

No. 2— Manufacturer, sample sent directly 
from factory 

No. 3— Manufacturer, sample sent directly 
from factory 



a 811, 249 
52,523,886 
a 4, 142, 068 
69,521,995 
a 3, 375, 527 
69,493,670 



a 1,010, 509 
61,010,509 
a 2, 552, 676 
61,495,066 
"4,173,622 
6936,065 



a 3, 349, 733 
6 628,074 

a 2, 603, 421 
6464,000 

a 1, 055, 966 
6 422,386 



a 4, 405, 286 
61,664,218 
a 4, 550, 050 
6 3, 993, 933 
a 4, 264, 870 
616,835,016 



SERIES II. 





Total number of organisms in— 


Source of ice cream. 


1 gram of 
fresh ice 
cream. 


1 gram after 
24 hours. 


1 gram after 
48 hours. 


1 gram after 
96 hours. 


1 gram after 
192 hours. 


No. 4— Low-grade confectioner . 

No. 5— Wholesale milk com- 
pany and dairy lunch 


f a 564, 381 
i 61,097,408 
f al, 006, 904 
1 65,418,105 


a 164, 000 

6201,786 

a 1,489, 361 

6 2, 765, 957 


a 140, 814 
61,804,180 
a 1,171, 613 
62,454,809 


a 149, 812 
6 2,536,315 

a 816, 405 
6 3,936,242 


a61,312 

61,021,867 
a 236, 709 










SERIES III. 










Total number of organisms in — 


Source of ice cream. 


1 gram of 
fresh ice 
cream. 


1 gram after 
24 hours. 


1 gram after 
48 hours. 


1 gram after 
72 hours. 


1 gram after 
120 hours. 


1 gram after 
216 hours. 


No. 6 — Cheap restaurant 
Avhich buys from manu- 
facturer of sample No. 1. 

No. 7 — Small bakery, prem- 
ises clean 

No. 8— Market-house lunch 
counter, ice cream made 


1 a 2, 668,777 
1 6 6,219,608 

fa 12, 460, 196 
[629,558,355 

a 510, 673 
I 6 714, 942 


a 298, 804 
61,090,637 

a 3, 231, 017 
62,670,974 

a 1,256, 645 
62,319,961 


a 709, 442 
6 855, 503 

a 4, 019, 523 
6 8,010,335 

a 1,424, 936 
6 1, 323, 155 


a 690, 000 
6 1, 189, 296 

a 12, 735, 849 
6 2,452,830 

a 776, 196 
6 217, 335 


a 292, 839 
6 2,352,163 

a 8, 052, 455 
6 2,300,701 

a 476, 338 
61,449,725 


a 153, 351 
6 946, 611 

a 644, 329 
6 5,257,731 

a 219, 499 
61,005,615 







a 37° C. 



6 18° to 20° C. 



268 



Table II. — Bacterial groivth in Ice cream thawed and refrozen. 





Total number of organisms in — 


Source of ice cream. 


1 gram of 
cream. 


1 gram of ice 
cream. 


1 gram of 
melted ice 

cream 14 
hours after 

freezing. 


1 gram of re- 
frozen cream. 


1 gram of ioe 

cream 7 
hours after 
refreezing. 


Experiment 1— Home-made, va- 


f al, 142, 640 
1 61,158,886 


a 274, 254 
6351,219 


a 57, 090 
6331,125 


a 32, 829 
6306,412 


a 28, 774 
632,696 






Total number of organisms in— 


Source of ice cream. 


1 gram of 
cream. 


1 gram of ice 
cream. 


1 gram of 
melted ice 

cream 23 
hours after 

freezing. 


1 gram of re- 
frozen cream. 


1 gram of ice 

cream 5 
hours after 
refreezing. 


Experiment 2— Home-made, va- 
nilla 


f a 2, 926, 421 
{ 67,525,125 


al, 144, 016 

63,874,896 


a 897, 867 
62,244,668 


a 614, 463 
6732,629 


al, 541, 501 







a 37° C. 



618° to 20° C. 



All of the samples which have been studied for cold storage his- 
tory were examined also for the presence of streptococci. The re- 
sults are indicated in the following list : 



Num- 
ber. 


Streptococci. 


Num- 
ber. 


Streptococci. 


1 
2 
3 
4 


Not found. 

Present — short chains — numerous. 
Present — long chains — very numerous. 
Present — short chains— few. 


5 
6 

7 
8 


Present— short chains — few. 
Present— long chains— numerous. 
Not found. 
Not found. 



Eighty-two and five-tenths per cent showed the presence of the 
organism. 

The method for the detection of streptococci in ice cream was as 
follows: The melted sample was centrifuged for half an hour in a 
Stewart lactocrite driven by a small motor of such power that the 
speed was approximately 3,000 revolutions per minute. This appa- 
ratus, which consists of a flat aluminum pan holding 20 tubes of 1 
cubic centimeter capacity and stoppered at the outer end with a spe- 
cially constructed rubber plug, causes the sediment not only to be 
thrown to the end of the tube but drives it against the rubber plug 
with such force it is almost quantitatively adherent to the plug. 
Accordingly, if one carefully removes the rubber stopper and by rub- 
bing on a glass slide and over an area of known surface attaches the 
sediment, one can obtain, on staining and examining the film micro- 
scopically, an approximation of the number of organisms and leu- 
cocytes in 1 cubic centimeter of the liquid. 



269 

Because of the debris in ice cream, which ordinarily renders the 
usual method of centrifuging milk and cream samples quite imprac- 
ticable, the above method was resorted to and, so far as the detection 
of the presence of streptococci was concerned, it was found eminently 
satisfactory. 

THE SIGNIFICANCE OF A PURE ICE CREAM SUPPLY IN RELATION 
TO PUBLIC HEALTH. 

A study of the literature dealing with diseases traced to the eat- 
ing of ice cream shows that not only are isolated cases more or less 
severe, even sometimes resulting in death, fairly numerous, but wide- 
spread epidemics have been caused by the toxicity of the substance. 
Such diseases are, of course, of gastro-intestinal origin. Among 
these epidemics is one of typhoid fever described by Dr. George Tur- 
ner, occurring at Depford in 1891, which was apparently caused by 
ice cream. 

Another epidemic of this disease occurred in Liverpool in 1897 
to Avhich 27 cases were traced. 

In 1902, in the city of London, 18 cases of typhoid fever were 
traced by the health officer of Finsbury (see report of health of Fins- 
bury, 1902, page 67) to ice cream as the source of infection. 

More commonly, however, the illness caused by ice cream has the 
symptoms of colic, headache, diarrhea, and depression rather than a 
specific typhoid infection. " Such an outbreak occurred in Birming- 
ham during the summer of 1905 (Thresh & Porter, Preservatives in 
Foods and Food Examination, page 280) and was investigated by 
Dr. Eobertson, the city medical officer of health. Out of 250 con- 
sumers served 52 cases of illness occurred, 4 only of the patients being 
over 14 years of age. The interval which elapsed between the eating 
of the ice cream and the onset of the illness varied from half an 
hour to eight and a half hours. All the persons suffered from diar- 
rhea and collapse. No irritant poison was discoverable by chemical 
analysis. Professor Leith examined the ice cream bacteriologically 
and found therein a bacillus of the colon group capable of causing 
the death of guinea pigs. From an examination of the premises in 
which the ice cream was manufactured it appeared probable that it 
had become contaminated while standing in the cooling shed after 
boiling and before freezing. Opposite this shed there were 3 water- 
closets in an extremely filthy condition, and possibly organisms of 
excremental origin had fallen upon one of the buckets of the cream 
while it was in a warm condition. These would rapidly multiply and 
may have produced toxins or ptomaines. Neither the bacilli nor their 
poisonous products would be affected by the subsequent freezing." 



270 

In the discussion of ice cream in " Bacteriology and Public 
Health," by George Newman, he states that a " small outbreak oc- 
curred in the city of London, affecting 16 telegraph boys. The 
symptoms were colic and diffuse abdominal pains, headache, vomit- 
ing, diarrhea, and nervous depression. Dr. Collingridge's inquiry 
resulted in the following conclusions : 

(1) That in a number of cases # of illness occurring among young persons of 
a susceptible age the symptoms were strictly identical and were characteris- 
tic of poisoning by ingestion of toxic material. 

(2) That the cases reported followed the ingestion of ice creams. 

(3) That ice creams subsequently obtained at shops frequented by the pa- 
tients contained bacilli of a virulent character. 

(4) That the symptoms observed were those generally following the inges- 
tion of material containing such bacilli. 

(5) That where pathogenic bacilli were found, the ices had been manufac- 
tured under insanitary conditions. The majority of the manufacturers are 
aliens, and although the premises may be kept in a fairly sanitary condition, 
their personal habits unfortunately leave much to be desired where the prepar- 
ation of food is concerned." 

Dr. Klein examined 24 samples of ice cream from the same locality 
and found 13, or 54 per cent, to be poisonous to guinea pigs. 

In July of 1904 the medical officer of health of Battersea (Report 
of 1904, Public Health Committee of the London County Council) 
reported an outbreak of illness among the people who had eaten ice 
cream purchased at a particular shop. As usual in such toxemias 
the symptoms included abdominal pain, diarrhea, and collapse. 
The ice cream causing these poisonings had all been eaten and there- 
fore could not be examined, but an inspection of the premises showed 
very filthy conditions and in all probability the contamination of 
the cream was due to a dust bin in the immediate proximity of the 
shelf on which the ice-cream vessels were stored. 

Owing to outbreaks of this nature the London County Council 
(general powers act, 1902, sees. 42-45) has given powers for control- 
ling this trade : 

(a) Ice cream must be made and stored in sanitary premises. 

(6) It must not be made or stored in living rooms. 

(c) Strict precautions must be taken as to protection from contamination. 

(d) Cases of infectious disease must be reported. 

(e) The name and address of the maker must appear on street barrows. 

These regulations are new for London, though they have practi- 
cally been in existence in Glasgow since 1905, and in Liverpool since 
1898. 

That such powers are enforced by the officials having the public 
health of London in charge is demonstrated by the report, for ex- 
ample, of the sanitary conditions relating to the city of Westminster 



271 

for the year 1903. (Francis J. Allan, medical officer of health for 
the city of Westminster.) 

Premises where ice creams are manufactured or sold were frequently in- 
spected during the year; there were 108 premises other than hotels and 
restaurants where ice cream is manufactured and sold. Proceedings were 
taken against Pietro Necchi, 36, Berwick street, under the London County 
Council general powers act, 1902, for manufacturing ice cream in a room used 
as a sleeping room, and he was fined £2 and £2 2s. costs. 

Every itinerant vendor of ice cream, etc., is required to exhibit the name 
and address of the manufacturer on his barrow. One man was cautioned under 
this section. Lists of such vendors were prepared in several boroughs, and 
the medical officers of health gave one another information with regard to the 
places where the ice cream is made. There were 18 persons selling it in the 
city during the year, of these several resided in the city (of Westminster), 
the others came from Finsbury (4), Holborn (3), Chelsea (3), and Lambeth 
(1). In one case the medical officer of Chelsea informed me that the place 
in which the mixture was prepared was dilapidated, with water-closet ob- 
structed, and defective paving of scullery. In another (in Holborn) pro- 
ceedings were taken for making ice cream in a living and sleeping room. 

The significance of the streptococci as a disease-producing organ- 
ism in ice cream has been briefly discussed in the section of this 
report devoted to bacteriological findings of ice cream in the city of 
Washington, and to that section the reader is referred. Aside from 
the invasion of the organism by living pathogenic bacteria, and the 
characteristic symptoms following such invasion, there must not be 
forgotten the causation of illness by products of the bacteria them- 
selves — even though they as living cells may have been eliminated 
either by boiling, freezing, or the use of chemical preservatives. It 
is commonly supposed that the manipulation through Avhich the 
mixtures for ice creams are apt to go, namely, pasteurization or 
scalding of at least a portion of the ingredients would tend to lessen 
the actual number of organisms present and to kill those which are 
commonly considered to be pathogenic. So far as the lessening of 
the number of organisms is concerned, the investigations embodied 
in this report offer an emphatic denial; and the heat or cold to 
which the mixture is exposed would be absolutely without effect 
upon the toxins or ptomaines produced by the organisms even should 
the latter be killed. 

Indeed, it may be very seriously questioned whether preliminary 
heating of the milk products going into the compounds known as 
" ice cream " is not actually deleterious and responsible, to some 
extent, at least, for such cases of poisoning as are included under 
the popular term of " tyrotoxicon." It has been definitely established 
that the scalding or commercial pasteurization of milk and cream 
of the usual commercial quality tends to kill off the organisms pro- 
ducing lactic acid and naturally causing the milk to curd, but leaves 



272 

behind the organisms more resistent to heating and which are apt 
to be those forming, as part of their excreted product, alkaline sub- 
stances, which — as the acid forming organisms are not there to 
give them combat — increase to such an extent that the reaction of 
the milk itself becomes distinctly alkaline. 

Ptomaines are chemical substances built on the ammonia type and 
are most commonly produced by bacteria coincidental with an alka- 
line reaction, or in a medium which has previously been made alka- 
line in reaction. Any condition therefore which produces in milk 
or its products circumstances favorable to the production of pto- 
maines is undesirable. The fact that the great majority of reported 
cases of ice cream poisoning are to be traced to the use of cheap grades 
of material would tend to confirm the foregoing supposition, since 
these cheaper grades of ice creams are commonly made of milk, eggs, 
gelatin, and such thickeners as require heating in order to produce 
the desired result. 

The use of condensed milk in cheap grades of ice cream is by no 
means uncommon. Indeed, with the increased activity of the con- 
densed-milk agent and the increased demand — particularly in large 
cities — for fresh milk, the practice is growing more and more popu- 
lar, and such condensed milks and those substances known as " evap- 
orated creams," which are only whole milks concentrated, are far 
too apt to usurp the place of true cream in the manufacture of ice 
creams. 

The contention has been raised by the makers of ice creams that the 
proposed Federal standard of butter fats is too high to be healthful 
and that an ice cream containing the amount of cream required by 
the Federal law can not be digested by many people. They assert, 
however, that an ice cream containing milk, eggs, and sugar, with 
such a thickener as cornstarch or gelatin, can be digested by, and is 
grateful to, those with whom the true ice cream does not agree. It 
is widely known, however, among those who have had experience in 
the feeding of invalids, convalescents, and persons having impaired 
digestive organs, that the unification of 3 of our most concentrated 
foods — such as milk, eggs, and cane sugar — produces a combination 
which is difficult of digestion and the feeding of it is often impossible. 
In such cases the patient can assimilate either of the ingredients 
separately, or any two in combination, but the third concentrated 
food when mixed with the other two is more than the organs can 
metabolize. 

Such being the case it would seem doubly desirable from the stand- 
point of the physician and the hygienist that there should be on the 
market a standard preparation consisting exclusively of cream, sugar, 
and flavoring, and of a definite fat content, that he may know what 
is being fed to his patient. 



273 

The correct labeling of the frozen mixtures sold at retail would 
also enable the person, who by experience has found that pure cream 
ice cream is or is not suited to his digestive organs, to obtain that 
which does agree with him. 

Not only is the chemical composition and the bacteriological de- 
composition of ice creams Avidely discussed in the literature from the 
standpoint of food value and desirability, but there comes from Italy 
an article by Baldoni, in the " Riforma Medica " for 1907, in which 
he attributes much of the digestive disturbance in Rome during the 
summer time to the contamination of ices by tin and lead, which are 
scraped off the inside of the freezing can by the mechanical action of 
the dasher. Baldoni has not only proven the presence of these metals 
in ices in a dissolved condition, but by careful filtration he has iso- 
lated macroscopic particles of both lead and tin. 

The container of ices, etc., commercially, is a metal cylinder, in 
which products having various fruit flavors are stored for consider- 
able lengths of time. In some cases the material melts, warms up 
very thoroughly, and is again frozen. It is perfectly possible that a 
mechanical distribution of particles of metal throughout the mass, 
and the long-continued action of fruit juices on these small particles 
as well as on the surface of the container, result in the accumulation 
in the food stuff itself of very appreciable quantities of metallic salts. 

DEFINITIONS AND DESCRIPTIONS OF ICES IN TRADE AND OTHER 

BOOKS. 

In an anonymous work entitled, " Ice Cream and Cakes," by an 
American, published by Chas. Scribner & Sons, in New York in 1901, 
the materials for making ice cream are described as follows : " Cream, 
sugar, eggs, flavors in variety, fruits and their juices, ice and snow, 
salt. Cream is classified by the author as single, double, and butter 
cream. Single cream is that which is skimmed from milk twelve 
hours after milking, double cream twenty-four hours after milking, 
and butter cream thirty-six hours after milking. No mention is 
made by this author of cream which is separated mechanically and 
which practice is now more frequently used for ice cream perhaps 
than any other. The author states that for making ice cream only 
the double cream of entire purity should be used and as soon after 
skimming as possible. On page 15 the author says : 

Milk should not be used, either wholly or in part, in place of cream. Its 
watery portion freezes into coarse crystals that give a snowy, mushy taste to 
the ice cream, which even the use of eggs does not correct, and causes it to 
melt much more rapidly than when made of pure cream. 

To prevent this and give the appearance of genuine ice cream some makers 
put in gelatin, to keep it firm, as they say. But its taste betrays it; neither 
45276°— Bull. 56—12 18 



274 

gelatin, tapioca, cornstarch, arrowroot, or any other makeshift will compensate 
for the absence of pure cream. 

The use of milk should be discountenanced by all who would have and enjoy 
ice cream of the best quality. In truth, when made of milk and eggs and not 
cream the product is frozen milk custard. 

By the same author the American type of ice cream is called " Phil- 
adelphia," and the following statement is made : 

Perhaps in no place in America can the Philadelphia ice creams be found of 
higher quality than at a first-class confectioner's in the City of Brotherly Love. 
Certainly nowhere else can the chief material, pure cream, be obtained of 
greater richness and more delicious flavor. 

This is somewhat misleading, since there are doubtless hundreds of 
places in the United States where just as good cream with just as fine 
flavor can be found as in Philadelphia. 

The American anonymous author above mentioned recommends the 
use of eggs in that variety of ice cream known as " Neapolitan " 
which, however, in its own country is not called a cream. He states 
that the Neapolitan ice creams do not differ from the Philadelphia 
creams except in the use of eggs in their composition. Types of Ne- 
apolitan ices are made according to the formulas given in the book; 
the most popular one is called vanilla, No. 53 — which is made of 2 
quarts of cream, 12 eggs, 1J pounds sugar, and 1-J ounces of a mixture 
of 1 pound of sugar with 1 ounce of finely powdered Mexican vanilla 
bean. In regard to the Philadelphia ice creams the author says, on 
page 60: 

Although some of the best confectioners in the Quaker City make their 
creams somewhat after the Neapolitan method, in proportions varying from 6 
to 1 egg for 1 quart of cream, some using the whole egg, others the yolk only, 
yet the plain creams without eggs for which that city has long been famous 
have become so generally known by its name that the title is here retained as 
their proper and distinctive designation. There is no other name for them. 

The question of the relative qualities of the Neapolitan and Philadelphia 
creams is one of either education, taste, or comfort. Those who are fond of 
eggs and custards will prefer the former ; those who are partial to pure cream, 
as well as those with whom eggs do not agree, will choose the latter. 

A typical formula for the vanilla cream is also given on page 60 as 
follows : 

Three quarts of cream, li pounds of sugar, and 1| ounces of the mixture of 
sugar with finely powdered Mexican vanilla bean, above described. 

Following this recipe are given recipes for chocolate, chocolate cara- 
mel, coffee, white coffee, caramel, pistachio, almond pistachio, almond, 
sweet almond, burnt almond, orgeat, filbert, burnt filbert, hazelnut, 
walnut, chestnut, lemon, orange, pineapple, banana, strawberry, 
raspberry, peach, apricot, nectarine, plum, cherry, apple, currant, and 
grape. In none of these are any components admitted except the 
cream and sugar, save the proper flavoring matters derived exclu- 



275 

sively from the substances mentioned. This classification is by far 
the most rational and satisfactory of any that I have been able to find 
in other authors. Nearly all the other authors admit indiscriminately 
to the name of ice cream all the various compounds which have been 
described. 

Among other authorities of this kind I may mention " Mrs. Lin- 
coln's Boston Cook Book," Roberts Bros., edition of 1897. This author 
gives the formula for Philadelphia ice cream and Neapolitan ice 
cream exactly in harmony with the author just quoted. The follow- 
ing naive statement is made on page 363 : 

If cream can not be obtained beat the whites of the eggs till foamy, and add 
them just before freezing. No matter how many eggs are used, a little cream, if 
not more than half a cupful, is a decided improvement to all ice creams. It is 
better to make sherbet or fruit and water ices than an inferior quality of ice 
cream with milk. Ice creams are richer and mold better when made with 
gelatin, but care must be taken to flavor highly to disguise the taste of the 
gelatin. 

In "Mrs. Rorer's New Cook Book," edition of 1903, it is stated, 
page 600 : 

To make good ice cream it is first necessary to have a good quality of cream. 
Scald half the cream to prevent excessive swelling. Where fruits are used they 
must be mashed and added after the cream is frozen. 

The formula for peach ice cream admits only cream, the fruit, and 
granulated sugar. The same is true of strawberry ice cream and rasp- 
berry ice cream. In chocolate ice cream as much milk is admitted as 
there is of cream. For vanilla ice cream nothing is admitted except 
cream, vanilla bean, and sugar. It is seen, therefore, that Mrs. Rorer 
upon the whole, with one exception, admits nothing but cream, flavor, 
and sugar into her products. 

Mrs. Mary J. Lincoln and Anna Barrows, in a work entitled " The 
Home Science Cook Book," describe ice creams and other frozen 
desserts on page 186 and following. The general name of frozen 
desserts is given to the whole class. The authors say : 

So many names are given to different frozen desserts that a few words of 
explanation are needed. 

ICE CREAM. 

This consists mainly ©r entirely of cream and takes a specific name from 
the substance used for flavoring. 

FROZEN PUDDING. 

Ice cream or custard, highly flavored, and containing preserved fruits and 
nuts becomes frozen pudding. 

In "Mary Ronald's Century Cook Book," edition of 1897, the 
author includes, p. 488, under the term " Frozen Desserts," ice creams, 



276 

water ices, parfaits, mousses, frozen fruits, punches, and sherbets. 
Ice creams are classified as follows : 

Philadelphia ice creams are cream sweetened, flavored, and stirred while 
freezing. 

French ice creams are custards of different degrees of richness stirred while 
freezing." 

Then follow the definitions of parfaits, bisques, and mousses, which 
are described as whipped cream with or without eggs, frozen without 
stirring. The author adds: 

These creams, in different degrees of richness and with different flavorings, 
give an infinite variety, and their combinations and forms of molding give all 
the fancy ices. 

Mrs. Ronald does not mention gelatin as a constituent of either 
straight ice creams or of any of the frozen custards or desserts which 
she describes. 

In " Paul Richard's Pastry Book." page 78, is found the follow- 
ing: 

The best and richest ice creams are made from double cream, with the 
addition of yolks of eggs, sugar, and flavorings, while some of the cheapest 
commercial creams are made from milk only, without eggs, and are thickened 
with gelatin, corn starch, arrowroot, sago, and other preparations. The rich 
creams which contain eggs and cream frozen in patent freezers are also termed 
New York creams, and the lighter creams, made from the best cream and with- 
out eggs, Philadelphia creams. 

On page 82 it is stated that the name Philadelphia ice cream 
" is generally applied to ice creams made with pure cream and with- 
out any eggs, although some makers use about 5 eggs to each gallon 
of cream, with 2 pounds of sugar." 

Under the head of commercial ice creams the author says : 

Where quantity is more required than quality ice creams are made from 
plain cream, half milk and half cream, and of milk only. Starch, arrowroot, 
and sago flour in proportion from 3 to 6 ounces to each gallon is boiled into 
a smooth batter with a part of the milk and the sugar, strained, cooled, and 
frozen. Gelatin should be soaked and dissolved in warm milk but not boiled, 
as this would cause the milk to curdle. About 1J to 2 ounces of gelatin are 
used for 1 gallon of cream and milk. Another thickener for ice creams is 
used cold. The preparation is known to the trade as cream-thick ; it is some- 
thing like a dry milk powder. The thickener is mixed with the sugar to be 
used, the cold milk or cream added gradually. As soon as the sugar is dis- 
solved the cream is ready to be frozen. 

Caterers' standard ice cream, best quality, according to Paul Rich- 
ards, is made after the following recipe : 

1 gallon double cream, flavor, If pounds sugar. The cream is made by the 
cold process and is used by the best caterers as a standard preparation from 
which are made many of the fancy creams, fruit, and nut creams. 



277 

In the " Ice Cream and Candy Makers' Factory Guide," edition 
of 1907, are found the following notes on page 4 : 

Scalding milk or cream means to bring it to the steaming point over hot 
water; never allow the material to boil. 

When part milk is used the cream may be whipped before freezing. 

If eggs are used cook them with the milk or cream. 

Well beaten white of egg added to a frozen sherbet makes it creamy and 
smooth; added to any of the creams will make it smoother and lighter. 

Good ice cream can be made without cream (part 5). 

The Philadelphia, or eggless, cream is best if fruits are to be added. 

Cream two or three days old is better than cream one day old. 

Scalded cream gives greater " body " and when frozen will have a fine grain. 

Ices made with too much sugar are hard to freeze and sometimes " ropy ;" if 
too little sugar is used they will be coarse and rough. 

Sour fruits should be added to the cream after it is frozen. 

Raspberries, lemons, and orange* make better water ices than ice creams. 

On page 5, the author quotes the national standards for ice cream 
and adds the following comment: 

It is generally thought that the standard has been set too high, but it is the 
law, and is in the right direction, as it protects the public against misrepresenta- 
tions, and against harmful ingredients ; besides it does not prohibit the ship- 
ment of creams that differ from the standard, but it simply requires the 
shipper to designate the actual quality by a label. 

On page 8, in describing the ice creams known as " Philadelphia," 
the author says : 

Includes all the various creams made of pure cream, without eggs. 

Part 7 of this work is devoted to " commercial " ice cream. The 
first formula given is that of " fortuna " cream, of which it is stated 
that this formula made a fortune for its originator. It is as follows : 

4 gallons 20 per cent cream, 1 gallon condensed milk, 1 gallon fresh milk. 
4 ounces gelatin, 7 pounds granulated sugar, 3 ounces vanilla extract. 

Chicago " picnic " ice cream is made as follows : 

14 quarts condensed milk, 10 quarts fresh milk, 8 pounds granulated sugar, 
8 ounces gelatin, 4 ounces vanilla. 

The " economy " formula for ice cream is as follows : 

9 gallons fresh milk, 10 pounds granulated sugar, 10 ounces gelatin, 4 ounces 
cornstarch, 4 ounces vanilla extract. 

The author says, after describing how the materials are mixed to- 
gether : 

It is now ready to freeze and when frozen will be smooth and fine grained 
and appear as if made from cream. It will never be blue and coarse, cheap 
looking, and cheap tasting, like milk mixtures generally. 



278 

The " Chicago " formula for ice cream is as follows : 

4i gallons cream, 1 gallon condensed milk, 7 pounds granulated sugar, 6 
ounces gelatin, 4 ounces vanilla extract. 

After describing the method of mixing and freezing the author 

says: 

Six gallons of this mixture will make 10 gallons of high-grade ice cream, 
rich and smooth. The cream should be several days old. 

Trade journals devoted to confectionery and ice-cream making 
have had much to say during the past two or three years respecting 
ice cream and the method of its manufacture. 

In the Confectioners' Journal of May, 1907, page 94, the editor 
says: 

Now for the ice cream and soda water. Use only the very best materials, 
and don't make the great mistake of thinking that this and that will do, but 
resolve that only the very best is just " good enough " and a good business with 
a fair profit will be the reward. As cream is the most important ingredient in 
the manufacture of ice cream, we wish to say a few words about the same be- 
fore we go into details of the manufacture of the ice cream. Cream is classi- 
fied as follows : Single, double, and butter cream. Single cream is that which 
is skimmed from milk twelve hours after milking, a " double " cream is allowed 
to stand twenty-four hours before it is skimmed, while butter cream — which 
does not come into consideration in this article — stands thirty-six hours before 
skimming. 

Gelatin is not mentioned by the editor as a component of ice cream ; 
he says, however, in speaking of water ices : 

In order to smooth water ice the addition of raw egg white is best, although 
glucose and gelatin are often used instead. 

In the same journal of June, 1907, on page 90, various formulas 
are given for making different kinds of ice cream and ices. The 
recipes given for ice cream contain no ingredients except cream and 
sugar and the flavor. The recipes given are for grape, banana, 
bisque, pistachio, peach, apricot, filbert, roasted filbert, walnut, pine- 
apple, cherry, and cocoanut ice creams. The formula for Neapolitan 
ice cream, however, includes the customary quantity of eggs. In 
"Answers to correspondents," on page 94, in describing ice cream to 
" N. M.," the Journal says : 

For 1 quart of evaporated cream use 2 quarts of milk, then add 11 pounds of 
sugar, stir, strain, and freeze. You may dilute the cream with 1 pint of water, 
but as this will make an inferior article we can not recommend it. 

In this connection it may be stated that the trade name " evaporated 
cream " is simply a name for condensed milk. Therefore the ice 
cream which the Journal recommends to " N. M." is not at all like 
that which it described in the editorial article. 



279 

In the same journal for August, 1907, are given additional formulas 
for ice cream. In speaking of Neapolitan ice cream the following 
language is used : 

This is no special cream ; it merely consists of 4 different flavors packed in 
layers into brick molds and cut into slices when served. The first layer being 
orange or lemon water ice, next strawberry ice cream, then chocolate, and lastly 
vanilla ice cream. 

This is quite a different compound from the formula for Neapolitan 
ice cream previously referred to in this same journal. 

In the same journal for September, 1907, page 101, is a description 
of u elk " ice cream, which is made as follows : 

Place 10 yolks of eggs into a farina boiler, add 2 vanilla beans, split in 
halves, set on a very slow fire, and beat the yolks until they form a thick body ; 
remove the boiler from the fire and beat until cold. Now make Italian meringue 
of 4 whites of eggs and 9 ounces of sugar, add this to the beaten yolks, and 
when the composition is entirely cold, add 1 strong pint of whipped cream. 
When the composition is well mixed, add 8 ounces of preserved fruits cut into 
small dice and soaked in good maraschino, and last, 2- ounces of finely crushed 
macaroons. 

It would be a little difficult if this were a puzzle to find the cream 
in the mixture. 

The same journal, page 24, gives a recipe for maple ice cream. It 
April, 1907, in response to a query asking for the formula of New 
York ice cream, makes the following statement : 

There are almost as many formulas for New York ice cream as there are for 
plain vanilla ice cream, different makers having widely different notions as to 
the proper ingredients and method for New York ice cream. 

Following this was a number of recipes for making a substance 
called " New York ice cream," each of them differing in essential par- 
ticulars from the others. 

The same journal, page 24, gives a recipe for maple ice cream. It 
is made of — 

1 quart maple syrup, 1 pound granulated sugar, 12 eggs, 2 quarts sweet 
cream, 20 per cent vanilla. Boil sirup and sugar and pour in a thin stream 
over the beaten eggs, whisking briskly. 

The editorial comment on the formula, which is furnished to Harris 
Brothers, Jamestown, N. Y., is as follows: 

It would seem that this mixture ought to make nearer 6 quarts than 4 (unless 
the machine is turned at slow speed) and still be very smooth and full bodied. 
The proportion of sweetening ingredients is abnormal. Cutting the sugar in 
half would improve the product. The milk fat contained is approximately 9.5 
per cent. 

It is evident that not only may ice cream, as commonly understood, 
be made of anything, but the journalistic advice is to swell it so as 



280 

to increase its bulk. This is interesting inasmuch as ice cream is 
bought by measure and not by weight. 

A " pure-food ice cream," the newest variety to which my attention 
has been called, is described in the June number of the Ice Cream 
Trade Journal, page 18. It is as follows : 

Sweet cream 5 quarts, cooked down to 1 gallon, being careful not to scorch 
it. It is cooled quickly in ice and stored until cold. This will raise the test 
of your cream and will give body to your ice cream. Formula is as follows : 

4* gallons, 20 per cent cream, 1 gallon condensed cream (your own make), 11 
pounds sugar, 3 ounces of best gelatin, 3 ounces of vanilla. 

The maker of the recipe adds : 

This ought to make 10 gallons of as high-grade ice cream as it is possible to 
make for smoothness, good body, and elegant flavor. All ice cream requires 
something to make it smooth and keep it so. If a State prohibits gelatin, would 
it permit the use of rennet? They allow it to be used in cheese, so how could 
they object to it in ice cream? About 6 tablespoonfuls would answer. 

The editor of the Journal makes the following comment: 

We can see no reason why anyone should object to the proper use of rennet 
in the manufacture of ice cream, but the fact remains that under a legal stand- 
ard for ice cream that failed to mention rennet as an admissible ingredient its 
use could not be permitted. 

The editor of the Ice Cream Trade Journal in the issue of August, 
1907, page 24, makes the following statement: 

SILLY ACTION PROPOSED. 

From many different parts of the country come reports that some ice cream 
manufacturers are preparing to change the name of ice cream in order to com- 
ply with or to evade the law, as you please. If manufacturers are making ice 
cream there is no occasion to change its name; if what they are making is not 
ice cream then it is not ice cream that is to be given a new or a changed name. 

There should be no change in the name of ice cream. What there should be 
is the stiffest kind of a fight, even in the face of dire threats emanating from 
Washington and divers State food-control camps, to retain the name " ice 
cream " for every kind and quality of product justly entitled to bear it by rea- 
son of having borne it since the time when the name came into common use as 
the common name of a class or group of ices differing from that class or group 
known by the common name of water ices. 

In the Ice Cream Trade Journal for September, 1907, in answer to 
the question " What is your best formula for French ice cream," the 
editor says : 

It is rather difficult to offer a best formula for French ice cream. Below 
we give two formulas, the second of which is similar to what is called Delmonico 
ice cream, except that the proportion of mix to finished product is greater. 

First formula, for 10 quarts : 24 whole eggs, 4 pounds sugar, 6 quarts cream, 
vanilla. 

Second formula, for 10 quarts : 3 quarts cream, 3 quarts milk, 2\ pounds 
sugar, 18 egg yolks, vanilla. 



281 

Really the chief difference between French ice cream and an American cream 
containing eggs is that it is much more solid and somewhat smoother because 
of its closer grain, and this is due to its being frozen in such manner that there 
is not much increase in bulk. 

The Ice Cream Trade Journal of October, 1907, contains a number 
of English formulas, submitted for the purpose of showing that 
English cream ice and American ice cream are similar products. 
Then follow 7 recipes for making different kinds of ice cream. All 
of these recipes contain eggs, but none of them gelatin or any other 
stiff ener. 

A small pamphlet entitled " Hand Book on Ice Cream," by Adolph 
Kramer, published by the Sioux Publishing Company and received 
at the Department of Agriculture on July 5, 1907, gives interesting 
information from the trade standpoint. The pamphlet is only 12 
pages of a single column each, and is sold for $5 a copy. On the front 
page occurs the following statement : 

This little booklet tells you how to manufacture a prime ice cream at 30 
cents per gallon equal to a full cream and perfectly healthful ; formulas for 
fancy creams, fruit ices, fruit frosts, sherbets, whipped cream, etc. This book- 
let is worth $100 to you. 

On page 3 occurs the following language : 

Ice cream at 10 cents per gallon sounds good to you, doesn't it? Of course it 
does. * * * Ice cream has been made and used in this country for over one 
hundred and ten years and it has increased in popularity every day since and 
will continue to do so. The Italians claim the honor of first presenting ice in 
solid form, and for that reason it is presumable that the name " Neapolitan " 
as applied to ice cream will never become obsolete. The name " Neapolitan " 
is applied to custard cream in general. It is also used to designate a fancy 
cream. The day for using a straight cream, testing from 25 per cent to 30 per 
cent of butter fat, has gone by and should go by, though some manufacturers 
claim they axe using 20 per cent butter fat test and producing all cream and 
that their trade is constantly increasing. However that may be a full cream is 
too rich for the ordinary person's stomach. Manufacturers should aim to pro- 
duce an ice cream that any person with a weak stomach should be able to eat all 
he wants without fear of being made sick, and such a cream is just as pleasing 
to the taste and just as healthful and far more satisfactory than a straight 
cream, not taking into consideration the extra profit for the manufacturer. The 
author has analyzed a large number of the preparations on the market which is 
used to improve and lessen the cost of ice cream, and when you have read this 
little booklet through you will be able to use your own preparations without 
paying someone else 1,000 per cent profit, like some of them on the market. 
Dextrine ! Dextrine ! Dextrine flour is one of the principal ingredients that 
does the trick. Now, this article is perfectly healthful and will give good satis- 
faction. It doubles the quantity, saves one-half the labor, saves one-half of the 
ice, and saves one-half of the salt, it keeps them twice as long, it will not sepa- 
rate, and will not ice. By its use whipped cream can be made of 25 per cent 
cream in half the time and stand twice as long as 50 per cent without it. It will 
make good ice cream from pure milk. 



282 

Then follow directions for making all forms of cream. On page 
9 is the formula for ice cream at 10 cents per gallon, which is as 
follows : 

It is possible to produce a good ice cream for 10 cents, figuring milk as 14 
cents per gallon. Here is the formula : 

Powdered gelatin 7 pounds, dextrine flour 3 pounds, mix thoroughly. * * * 
A powdered gelatin good enough for this may be bought for 20 cents per 
pound at the factory, and dextrine flour for 3 cents per pound. Dextrine may 
be bought from any glucose refinery. 

One pound of the above mixture at 15 cents and 5 gallons of milk 
at 14 cents a gallon are the directions given for the final process. 

The evidence cited shows that the products which have been sold as 
" ice cream " for many years in this country may be of almost any 
possible composition. We have found recommended for use in its 
composition, milk, skimmed milk, condensed milk, evaporated milk, 
vegetable gums, starch, dextrine, flour, eggs, gelatin, and other sub- 
stances. A formula has been offered for making ice cream that costs 
not more than 10 cents per gallon. It is evident that many of 
these substances are used simply because they are cheap and add 
bulk to the mixture and without any regard to their relations to 
health and digestion. So-called ice cream, having a definite name, it 
has been shown by the trade journals, is made up according to a half 
dozen formulas, so that it is impossible to state what an ice cream 
called by a definite name is. There is no uniformity followed in its 
manufacture, the sole object seeming to be to make it as cheap as 
possible and still secure a market therefor. It is evident from the 
authorities that the consumer is not given any kind of information 
at all when he purchases a substance known as ice cream, except per- 
haps that it is frozen. Even this does not seem at all times to be 
necessary, since ice cream has been offered and guaranteed to stand up 
for hours after it has been removed from the freezing machine. 

Having given in the preceding pages a summary of the authorities 
respecting the composition of ice cream, it is possible now to have 
a clear vision of the significance of this term in commerce before 
the advent of the food and drugs act. A study of the data will show 
in the first place that the frozen custard, which is said to have had 
its origin at Naples and which in this country has been known 
as Neapolitan ice cream, never was known in the country of its origin 
as ice cream, but by other terms entirely different in signification. 
In general, it may be said that the term ice cream is not used in any 
of the European countries, nor has it ever been used with the possible 
exception of its occurrence of late years in English menus, due to 
the crowd of Americans who visit England every year, especially 
during the summer season. The claim therefore that any kind of 
a pudding, or mixture of any description, has from the first been 
called ice cream does not appear to be sustained by the evidence. 



283 

In regard to the American custom, it appears plainly from the 
authorities quoted that there has always been made in this country a 
genuine ice cream composed solely of rich cream, sugar and harmless 
flavor, and this substance has been recognized and sold as ice cream 
from the very first. It has very often been designated in this country 
as Philadelphia ice cream, and this prefix indicated, at least to the 
trade, the character of the goods. The term " Philadelphia ice 
cream," however, would carry no meaning to the consumer except 
one of a geographical signification. The claim therefore which has 
been made that real ice cream has not always been made and sold 
in the United States does not appear to be verified by the authorities 
which have been cited. It is only fair to presume that Philadelphia 
is not the only town in which such ice cream has been made, but that 
it has been made very generally in all parts of the country. Hence 
it appears as established beyond any reasonable doubt that a real and 
genuine ice cream has always been an article of commerce. 

The claim that has been made that the people do not want genuine 
ice cream must be considered from two points of view. If by this 
is meant that the people in general want an ice cream as cheap as it 
can be bought, then the claim may be regarded as a fact. If, on the 
other hand, it is meant that consumers do not like the taste of genuine 
ice cream, there seems to be no evidence whatever in the way of its 
verification. Experience has shown that not only do the people, as 
a rule, like genuine ice cream, but they prefer it to any kind of frozen 
custard which may masquerade under the name of ice cream. The 
claim which has been made that genuine ice cream is not wholesome 
also lacks any kind of evidence. The fact that physicians prescribe 
genuine ice cream for invalids is an indication that it is regarded by 
the medical profession as a wholesome article of diet. It is undoubt- 
edly true that on account of its richness in butter fat genuine ice 
cream is an article of diet which should be consumed in some modera- 
tion, not only by the sick but also by the well. There is no evidence 
whatever to show that genuine ice cream is unwholesome in any 
degree except it may be contraindicated in certain diseased conditions 
of the stomach or digestive organs, or may be eaten in excessive quan- 
tities. These facts, however, can not in any sense be cited as evi- 
dence of unwholesomeness. On the contrary, it may be said with 
full assurance of verification that the average consumer prefers the 
genuine ice cream to any of the mixtures which may be substituted 
therefor. It is recommended by its organoleptic properties as supe- 
rior to the mixtures containing various added substances, used chiefly 
to give bulk or firmness to the mass. From the point of view of the 
general consumer the genuine ice cream is to be preferred for pala- 
tability to any of its substitutes. 



284 



ICE CREAM STANDARD. 

The standard for ice cream was suggested by the committee on 
standards after a long and careful study of the composition of ice 
cream, and the general character thereof, the meaning of the term, 
and the desirability of having it under the food law express some 
definite meaning. The form in which it was finally established is 
found in circular No. 19, of the Office of the Secretary of Agriculture, 
issued June 26, 1906, page 7. The standards read as follows: 

1. Ice cream is a frozen product made from cream and sugar, with or with- 
out a natural flavoring, and contains not less than 14 per cent of milk fat. 

2. Fruit ice cream is a frozen product made from cream, sugar, and sound, 
clean, mature fruits, and contains not less than 12 per cent of milk fat. 

3. Nut ice cream is a frozen product made from cream, sugar, and sound, 
nonrancid nuts, and contains not less than 12 per cent of milk fat. 

No standards were made for other varieties of ice cream. 

Before these standards were issued full opportunity was given 
to the trade to discuss the tentative standards which had been pro- 
posed and on which criticism and advice were asked. All this evi- 
dence was considered carefully by the committee before the final 
publication was authorized by the Secretary of Agriculture. Some 
of it was favorable to the creation of a standard and some opposed 
thereto. In order that the subject may be fairly presented, excerpts 
from this evidence are submitted. I give first the remarks made be- 
fore the standards committee at its meeting in Louisville in Decem- 
ber, 1906, by Mr. Samuel E. Kennedy, Pennsylvania, and then of 
others representing different views: 

Ice cream was originally invented by Florin in the city of Naples in sunny 
Italy about a century and a half ago and to-day it is still made and sold in 
Florin's cafe by his lineal descendants. It was composed of honey, fresh eggs, 
and sweet cream, which was frozen in long cylindrical shapes of various colors 
and served in a wine glass. * * * 

The agitation produced by the passage of the pure-food law, establishing a 
standard for ice cream has occasioned greater interest than anything heretofore 
known to the trade and all with one accord have begun to query and question 
" where are we at," and what will we do for a thickener and what formula or 
" mix " shall we adopt to comply with the new law which goes into effect upon 
January 1, 1907. 

The law defines ice cream to be composed of cream, sugar, flavor, nuts, and 
fruit; and the commission created under the law has set the standard at 14 
per cent butter fats for vanilla and chocolate ice cream and 12 per cent for 
fruits and nut ice cream. 

It has become the custom for several years past for the trade to use gelatin 
and refined glue under various proprietary names to " body up," and " thicken " 
and adulterate for the purpose, ostensibly of improving the product, with any- 
where from li ounces to 7 ounces of this product of the vat from abattoirs, 
consisting of horns, hoofs, pieces and scraps of skin, hides, shin bones, and 



285 

other unwholesome matter from our own and South American slaughterhouses. 
The respectable manufacturers or makers of ice cream did not use gelatin or 
other thickeners for the purpose of cheapening their product, but for the pur- 
pose of producing the velvet smoothness so much admired, and also for the 
purpose of insulating the frozen watery or aqueous portion of the cream and 
preventing it from swimming or turning into " soup," upon the slightest ex- 
posure. To avoid this dilemma, the cream had in the past been reenforced or 
''bodied up" by making custard (hot or cold), the old and ancient practice 
of adding fresh eggs and heating gently to form a custard or by adding corn- 
starch, arrowroot, potato starch, gum arabic, or tragacanth, ground gelatin, 
tapioca, etc., some of these not requiring heat to form a mucilaginous body in 
the cream, aided in keeping the ice cream firm. 

The use of same is now prohibited under the new law under a penalty that 
will prevent even the lawless from risking its execution. There is some hard- 
ship to the commercial ice cream in the double standard. Ice cream as ordi- 
narily made is run up in 10-gallon batches from 5| to 6 gallons " mixes," and 
after being " doubled " and " frozen," and then flavored, and rerun long enough 
to diffuse the fruit, extracts, nuts, coloring, etc., evenly and uniformly through- 
out the mass, it is then packed in " packers," or suitable tins to suit the cus- 
tomers' orders and hardened ready for sale, shipment, and delivery. 

Now, by this method it is quite impracticable to the ordinary manufacturer 
to make exactly the quality of the two standards, for instance, lemon and 
vanilla are flavored almost identically by the same quantity of extract, but 
the one under the law may contain 12 per cent butter fat and the other must 
contain 14 per cent, while chocolate ice cream, which is enriched by at least 
1 pound of cocoa butter fat, can be the same as vanilla. 

I would therefore respectfully ask the committee upon food standards to 
make a uniform standard of the lower quantity named, viz, 12 per cent and re- 
quire all ice cream to be made of that quality or above it. 

In making " runs " of " fruit " ice creams it is the practice to dip off a gallon 
of cream after being " run up " or " doubled " and fill in a gallon of crushed or 
macerated fruit, and thus the standard is involved, and there is a risk of an 
honest manufacturer disturbing the percentage, as ice cream in the soft state is 
difficult to measure with a dipper. 

Next the variation of the cream supplied to the manufacturer is beyond his 
control and would necessitate his calling in the chemist as a daily assistant 
to keep the milk dealer and creamery man up to his contract. 

The reputation of ice cream as a delicacy and a food for the sick was not 
achieved by the large manufacturers who now are the largest " calamity howl- 
ers " over the hardships of the new law, but by the small confectioners who 
made a neighborhood reputation, * * * but as ice cream became more and 
more popular, the machinery supply man began to manufacture machines for the 
trade, the long cherished secrets and formulas slipped into other hands and 
books of recipes were published. Then came the steam ice cream factory with 
its dirt and slop — dark, damp, noisome, underground, or above ground, in some 
stable or shed — the whirring and buzzing work went on and fierce competition 
drove down prices, and along came the " devil with his glue bags," tempting 
with his arguments, a " bigger yield," " less ice," " more velvety smoothness," 
" fast runs," " saving coal and ice," " nonmelting quality," use " more milk " 
" less cream," until after while " glue and water " began to play an important 
part in the largest establishments run by steam and electricity. 

There has grown into general use the last thirty or more years among the 
more respectable ice cream makers, the addition of a gallon of so-called heavy 



286 

evaporated cream or plain superheated condensed milk (unsweetened) to each 
4 or 5 gallons of 20 to 22 per cent cream. 

This was a pure whole milk concentrated " in vacuo " to about three to four 
times the thickness of the richest milk and served as a thickener without being 
foreign to the dairy or the cow ; this avoided the necessity for using thickeners, 
starches, cornstarch, potato starch, arrowroot starch, gums, gum tragacanth, 
Senegal, Arabic, etc., and made a beautiful smooth velvet-like product and 
double as much as cream alone would do. It had the advantage of purity, 
wholesomeness, digestibility, and cost about the same as cream. It would 
prevent the cream from swimming when dished up, or when transported long 
distances to customers who lived out of town in the summer time; but this 
formula was only used by the best family ice cream purveyors, as " glue was 
cheaper;" the "lordly mushroom" compounders could not afford to drop the 
large doses of water glue that enabled them to work up into "the only abso- 
lutely pure ice cream." 

The term cream should be also understood under the new pure-food law by 
the ice cream trade. 

The standard for cream calls for not less than 18 per cent of butter 
fat, and it is liberal in several respects, as it does not designate hand- 
skimmed cream, pasteurized cream, separator cream, centrifugal cream solidified 
cream, or evaporated cream, if they come up to the standard of not less 
than 18 per cent butter fat. This will be a great help to the ice-cream 
solidified cream, or evaporated cream, if they come up to the standard of not 
less than 18 per cent butter fat. This will be a great help to the ice-cream 
maker, for so long as he uses this or a higher standard he will be sure of com- 
ing up to the standard required by law. Some provisions should be provided 
under the law to suppress some grades of frozen mixtures now upon the mar- 
ket posing as cheap ice cream which do not contain cream, evaporated cream, 
whole milk, or a trace thereof, and which are sold to children who have only 
a few pennies to spend and want as much for their little sum as possible. 
While I recognize that frozen custard, frozen junket, and frozen jellies can be 
made clean and wholesome, I think it is but right that poor men's children 
should be safeguarded, and I hope that the pure-food commission and the com- 
mittee upon food standards will make a low standard as well as a higher one 
and will interest the Department in the subject so that the popular cheap 
frozen products within the reach of the humblest citizen may be safeguarded 
by the august eye of the law and be subject to the intelligent scrutiny of the 
chemical inspection of the Department. 

It is my opinion that all the trade are desirous of living up willingly to the 
standards, and in fact they see the beginning of better trade conditions and 
higher prices as a result. While it has placed them in a quandary as to how to 
proceed in the premises, as the instructions thus far have been quite meager, 
nevertheless I am confident they will be glad to accept the new standard. It 
would however materially assist if the Department would in due course issue 
a bulletin which would give instructions as far as deemed advisable by your 
Department. 

CRITICISM OF E. G. ECKERT AND OTHERS. 

Dr. E. G. Eckert, Secretary of the Ice Cream Manufacturers' 
Association of Pennsylvania, made the following statement at the 
national convention of ice-cream makers held in Chicago in Feb- 



287 

ruary, 1907. The account is taken from the Ice Cream Trade Jour- 
nal of February-March, 1907 : 

Pennsylvania is the Keystone State and seems to take the initiative in most 
things political. We do not have a Matthew Stanley Quay any longer, but we 
have some people who have learned politics from Matthew Stanley * * *. 
We are free-born citizens and we do not propose to have any commissioner of 
agriculture or his coterie of associates tell us what to do as against that which 
has been done for one hundred and fifty years. We had with us at Harrisburg 
Senator Tustin, chairman of this committee, who assured us that he recog- 
nized that there was an injustice being done to a manufacturing industry 
which ought not to be tolerated. We are untiring in our efforts to bring about 
the passage of a pure-food law which will benefit the public without injuring 
manufacturers and dealers. We do not want a law that makes standards. I 
am not in favor of any standard. When you ask for 1 per cent or 2 per cent or 
8 per cent of butter fat in ice cream, you are asking for an arbitrary standard. 
We are Americans. Our standard is as high as the heavens, and whatever 
people want and are willing to pay for give them. * * * You must get your 
State association organized and prevent the insertion in the agricultural bill in 
the Senate of a provision for standards. 

Mr. Thos. E. Lannen, a lawyer, also addressed the convention on 
the subject of standards. During the address he said : 

" My only suggestion at the present time on this standard for ice cream would 
be to adopt a standard which will permit you to conduct your business as you 
have been doing it in the past, and if there is any practice going on in your 
industry which is illegal and which in the minds of the majority of the men 
present here to-day should not be permitted then you should draft such a stand- 
ard as will stamp out that practice." 

Mr. N. Lowenstein, Secretary of the Sethness Company, of Chicago, 
in the course of his address respecting the standards for ice cream, 
said: 

" In answer to a telegram which I sent to the two Senators from Illinois 
I have a reply from one of them, reading as follows : ' Your telegram of re- 
cent date is at hand, and contents noted. Your suggestion relating to the pro- 
posed provision regarding food standards in the agricultural bill shall receive 
due consideration I can assure you.' " 

It may be said in passing that the ice cream makers were not the 
only persons who endeavored to have the authority to fix food stand- 
ards abolished. There are many other manufacturing interests which 
object to any standard whatever being set for their products. The 
standard, however, for ice cream to which objection was made was 
established long before the authority to establish standards was with- 
drawn. Continuing, Mr. Lowenstein said, speaking of the authority 
to fix standards: 

" Certain interests endeavored to have this same provision inserted in the 
agricultural appropriation bill of 1904, 1905, 1906, and again this year, and in 
each instance it was ruled out on a point of order as irregular legislation. 



288 

Efforts were made to have this objectionable provision reinserted in the Senate 
bill and a great many food manufacturers and organizations immediately com- 
municated with their Senators requesting that no one be given arbitrary power 
to fix food standards under the agricultural appropriation bill." 

Mr. Jackson, of Sterling, 111., said in the same Journal : 

My formula consists of milk, cream, condensed milk, and gelatin, and I 
worked that out by days of experimenting. * * * The result is I manu- 
facture 40,000 gallons of ice cream every year and I never have a complaint. 
I ship it from Sterling up to Dixon and to Freeport and over to Galena and 
down to El Paso, even down to Wheaton, a suburb of Chicago. One of my cus- 
tomers is the best drug store in Wheaton. The smallest children eat our ice 
cream in quantities. My youngest child was fed ice cream before he was 
through nursing. He is three years old now and gets from 2 to 3 dishes of it 
in hot weather, 4 or 5 if he wants them. The doctor's bill for my entire family 
is not over $5 a year. 

Extracts from the remarks of Mr. Chisholm read as follows : 

I believe in giving the people what they want. We have in our place gentle- 
men who make what they call a pure cream, cream that they do not use any 
gelatin or anything of the kind in. We have held customers against men who 
claim to make a pure cream of 14 per cent without any gelatin. People de- 
mand a cream that is not so rich as 14 per cent. I would like to speak a word 
in regard to what the gentleman from Sterling said about the question of cream. 
He seems to think that if we adopt that 14 per cent standard we shall decrease 
the amount of ice cream used. We very likely would. Suppose we decreased it 
25 per cent we would still have to increase the amount of cream we use in 
order to make that amount of ice cream, according to my way of figuring. 
Where are we going to get that cream ? It will not put the cream .back to the 
creamery ; we shall have to put up the price more than 20 per cent over what the 
creamery now pays, as he says he has been doing. In order to get the cream 
we shall have to take it away from the creamery and pure butter will go up. 
Suppose it does not decrease the amount of ice cream that we sell 25 per cent. 
If we are now making, say 7 per cent, take that as an illustration, if we go to 
making 14 per cent it takes twice as much cream as it does now. Where are 
we going to get it? It not only increases the price of cream we sell by the value 
of the extra cream used but all the cream we have to buy will cost us more 
money and we shall have to increase our price more than in proportion to the 
increase in butter fat. 

Mr. Woodhull called attention to the fight the ice cream makers are 
making against the standards. He said: 

We sent out some telegrams to-day that we would like to have ratified and 
made official by the association and spread on the record. We took it upon 
ourselves to send these telegrams, knowing that they should have been sent 
as soon as possible so we would not have to wait until evening. We have a 
telegram to the Hon. E. D. Crumpacker, who so brilliantly, earnestly, and sue- 



289 

cessfully took a stand in the House against irregular legislation being incor- 
porated in the agricultural appropriation bill : 

" The Hon. E. D. Crumpacker, 

" Washington, D. C. 
" The National Association of Ice Cream Manufacturers, in convention 
assembled, desires to thank you for your inestimable services through which 
you brought about the exclusion of the irregular legislation in the House appro- 
priation bill, thereby preventing the one-man power from destroying their 
industry. 

" J. H. Frank, President." 

President Frank : Gentlemen, Mr. Crumpacker is a Congressman from Indi- 
ana and he will do the right thing. Are you ready for the question? 

The motion was then put and unanimously adopted. Another telegram was 
sent to 
" Senator Proctor, 

" Chairman Committee on Agriculture, 
" Senate Chamber, Washington, D. C. 
" The Illinois Association of Ice Cream Manufacturers, in convention as- 
sembled, earnestly requests that you do not allow reinstatement in agricultural 
appropriation bill of parts stricken out in the House from bureau of chemistry 
section. 

(Signed) "Illinois Association of Ice Cream Manufacturers, 
" R. A. Woodhull, President" 

Mr. McCrea said : 

" The man who goes out into the field to compete for business and sells 
frozen water for ice cream is not a success, and you know it as well as I know 
it." 

President Frank : 

" They come pretty near doing it sometimes." 

After much discussion a rising vote was taken as to whether the 
convention should recommend to the commission a 14 per cent butter- 
fat standard, an 8 per cent butter- fat standard, or no standard at all, 
and the last proposition was carried by an overwhelming majority. 

The above quotations from the proceedings of the Ice Cream 
Convention are given to show that the product which is sold as ice. 
cream, or at least was sold as ice cream before the enactment of the 
food law, has no definite composition. No one can have any idea, as 
is shown by the statements made by the makers themselves, what the 
substance purchased as ice cream really is. As the President of the 
Association very aptly remarked, " Some of the members evidently 
were selling frozen water as ice cream, or nearly so." 

In The Ice Cream Trade Journal, October, 1906, page 23, there is 
an editorial article on " Butter Fat in Fine Ice Cream." This article 
states that the late Charles Ranhofer, who was for many years chef of 
Delmonico's, in his work entitled " The Epicurean," published in 
1894, devotes 50 pages to ice creams and ices. In quantity of butter 
45276°— Bull. 56—12 19 



290 

fat the plain creams which he describes are as a rule richer than his 
fancy creams. The editor says : 

Under the head of " Vanilla Ice Creams " you will find instructions for mak- 
ing 9 kinds. One, a fancy ice cream, contains no milk or cream whatever. One 
is similar to New York ice cream, or frozen custard, and has a butter-fat con- 
tent of about 2 per cent. Four others roughly calculated are well under 10 per 
cent of butter fat. One shows 11 per cent, one 14, and one 17. * * * We 
find that the butter-fat content is low in the majority of ice creams. True a 
few formulas show a high percentage of butter fat in the mixture, but, on the 
other hand, we find a number of formulas for ice cream that do not call for 
any cream and we have drawn attention to one that leaves out milk as well as 
cream. It is evident that a quality standard for ice cream specifying a mini- 
mum butter-fat content, unless that minimum is low, would prevent the sale of 
many fancy frozen dainties that were sold as ice cream before hokey pokey was 
invented. * * * For anyone to say that the term " ice cream " covers less 
to-day than it covered fifty years ago is absurd; therefore a standard that 
requires 6 out of 10 ice creams to be sold under another name is absurd. There's 
an old saying — not wholly untrue — that the law is an ass, but is it necessary 
in order to prevent fraud for those charged with the enforcement of the law to 
be absurd? Ice cream is a compound in which (except in rare cases) the 
principal ingredients are milk products, but if one reduces the butter-fat con- 
stituent in his compound or eliminates it and substitutes something equally 
wholesome and nourishing who shall say that he has not made ice cream as 
good as or even better than ice cream containing a specified percentage of butter 
fat? While we do not believe that a standard specifying the butter-fat content 
in ice cream is necessary to prevent fraud the establishment of a reasonable 
standard would prevent the sale of cheap frozen compounds unless they were 
plainly labeled to indicate their character, and this we believe would necessarily 
preclude their being served in individual portions, as in restaurants and at soda 
fountains. But what is a reasonable standard? Certainly not a standard 
that fixes the minimum butter-fat content above 8 per cent nor a standard that 
does not admit of the substitution of fresh eggs for butter fat pound for pound. 

The Kymo Company, manufacturers of food preparations, of Little 
Falls, N. Y., under date of February 25, 1907, submitted a protest 
against the standards for ice cream. The reasons for demanding a 
change are as follows: 

Inclosed, we hand you an amendment to the national definition for ice cream 
as given in circular No. 19. To our amendment we have appended an argument 
setting forth briefly numerous reasons why the present national definition 
should be repealed or amended to agree with our definition. You will find a 
recapitulation of our reasons on the last two pages of the inclosed argument. 

Because the States show a disposition to adopt the national standards we 
deem it very important that these be as nearly right and just as it is possible to 
make them. If they are not just and right those States that accept them will 
be led into errors that will in some cases result in hardships to its citizens. On 
the other hand, those States that refuse to accept the faulty standards will 
not be in full accord with those that do, nor with the National Government in 
the very important work of suppressing the traffic in adulterated and harmful 
foods and drugs. 

If the Agricultural Department or those in control of the matter of standards 
insist upon unreasonable standards like that for ice cream, will not the public 



291 

generally, especially the manufacturing element, combine with more sordid 
interests to bring about the abridgment or extinguishment of the power and 
authority to make standards? 

Believing that the national definition for ice cream is very faulty and will 
work untold hardships to manufacturers and consumers alike, especially if 
adopted by the States, we respectfully submit our definition and argument. 

The definition proposed by the Kymo Company is as follows: 

Ice cream. — Ice cream is a frozen product made from cream or milk, fresh 
or condensed, and sugar, with or without a natural flavoring and with or with- 
out the addition of other harmless vegetable and animal ingredients or products. 

The company also says: 

The term ice cream as now used is not a misnomer nor is it misunderstood by 
the consumer. This name is established in the minds of the manufacturer and 
consumer alike as that of an article that is made from recipes or formulas that 
vary greatly as to their ingredients. The consumer thus makes or purchases 
ice cream of a kind or quality that accords with his taste or means. There is 
no evidence of dissatisfaction on his part with the present popular definition or 
with the present product, therefore there is no cause for a new definition or for 
legislation along this line on the grounds that the public is being deceived or 
imposed upon by the sale of adulterated or misbranded ice cream. 

The term ice cream, in the minds of the consumer and the manufacturer, 
does not indicate that the frozen product is made from any particular amount 
or proportion of milk fat. To those who are conversant with the art of manu- 
facturing ice cream, including the confectioner, baker, caterer, and house- 
wife, the name suggests a variety of ingredients, and the quality of the arti- 
cle is not based on the amount of milk fat contained. * * * 

From the foregoing, it is obvious that to protect the public it is not neces- 
sary to restrict the term " ice cream " to frozen cream, sugar, and flavoring, 
as this is not the popular definition and is not what the consumer makes when 
he manufactures his own product. To the consumer and manufacturer alike 
ice cream made according to the Agricultural Department's definition is a new 
product under an old and familiar name. 

We believe that most doctors will agree that 14 per cent of milk fat in ice 
cream is a larger proportion than is good for the average individual. This 
is particularly true during warm weather, when ice cream is consumed most 
liberally. As regards healthfulness, whether taken as a food or as a cooling 
confection or delicacy, we believe that a pure milk ice cream is preferable to 
one made from pure cream, just as much so as milk is better than cream for 
the average individual to drink. 

The Kymo Company also makes the following statement regard- 
ing the determination of the percentage of fat : 

In all that we have seen or heard on the subject of how to figure the per- 
centage of fat in ice cream the basis has been the relation of the milk fat to 
the entire weight of the raw materials. On this basis it has been estimated 
that cream testing 17 per cent will produce ice cream showing 14 per cent of 
milk fat. If this figuring is accepted ice cream made in a slow-speed power 
freezer will cost nearly double as much as that made from the same materials 
in a freezer that whips the materials into double its original volume. Does 
this not look like discrimination in favor of the man with the high-speed 
freezer? 



292 

The company also makes the following observations upon the very 
common practice at the present day of practically doubling the vol- 
ume of ice cream. As ice cream is chiefly sold by volume it is evident 
that any process which will make out of a given amount of materials 
double the volume must be a source of profit to the manufacturer. 
Just what benefit this expansion of volume is to the consumer does 
not plainly appear: 

As is well known, most wholesale manufacturers make 40 quarts of ice cream 
from 20 quarts of materials. What is to prevent the manufacturer from still 
further diluting with air his 17 per cent milk fat cream if the test for the milk 
fat is on the basis of the weight or volume of the raw materials or of the melted 
product ? 

If we must have a milk -fat standard let it be one that will result in uni- 
formity in the finished product under all processes of manufacturing and that 
will not give the man with the fastest freezer a practical monopoly. If the 
Department must have a standard let it be one that will not tempt the manufac- 
turer to neutralize the increased cost of his raw materials by increased expan- 
sion. 

The force of the above argument is not apparent. Inasmuch as the 
percentage, unless otherwise stated, is always a percentage on weight 
it does not make any difference in the estimation of the percentage 
whether the materials have been expanded to 2, 3, 4, or 5 volumes. 
The relative weight of fat to the materials is not changed by the pro- 
cess of expansion, since the air which is used in the expansion is prac- 
tically so light as to add nothing of any consequence to the weight of 
the expanded article. 

Great stress is laid by the Kymo Company upon the fact that ice 
cream which contains 14 per cent butter fat is a new product not 
known hitherto to the trade. The company says : 

In view of the facts related in the foregoing, we suggest that if the Govern- 
ment or the Agricultural Department requires a name for the product of its 
definition it either select a specific name that will not interfere with established 
trade conditions or let the term ice cream apply generically as it does to other 
frozen confections. As a specific name for the Department's new product we 
might suggest the following: "Pure cream ice cream, cream ice cream, cream 
ice, iced cream, or frozen cream." The term cream, however, would not have 
the same significance in the Department's 3 definitions because of the variation 
in the milk fat in those definitions. 

Apparently a more just construction of the requirements would be 
to require a definite name for the variations instead of for the pure 
article, thus introducing the names " Milk ice cream, skimmed milk 
ice cream, condensed milk ice cream, evaporated milk ice cream, 
gelatin ice cream, egg ice cream, coal tar dye ice cream," etc. 

Summarizing, the company closes its remarks as follows : 

We believe that we have shown conclusively — 

First. That there is no need of a new definition or standard for ice cream. 



293 

Second. That ice cream as made by present processes is noninjurious to 
health and satisfactory in quality to the consumer. 

Third. That the manufacturer and consumer are at one in their respective 
understandings of the term as now used. 

Fourth. That the present process of manufacturing, including the formulae, 
accords with the accepted meaning of the term in our standard dictionaries, 
also with its history. 

Fifth. That it is not misbranding to apply the term ice cream to the usual 
frozen products by that name. 

Sixth. That cream is not a specific term used only as a name for the fatty 
part of milk, this being one of several applications of the word. 

Seventh. That Article f of Regulation 12, Section 8, does not apply to ice 
cream, as the name of this article is not derived from one of its constituents but 
from its own qualities as a product. 

Eighth. That the process to which the Agricultural Department proposes to 
apply the term is not the ice cream of commerce or the home, but a new product. 

Ninth. That no definition fixing a standard of milk fat is practicable or 
desirable. 

Tenth. That the term ice cream has become a valuable trade name, the 
establishment of which, by advertising and other means, has required the ex- 
penditure of large sums. 

Eleventh. That, without good cause, the Government has no right to con- 
demn the term ice cream for application exclusively to another product. 

Twelfth. That, as a model for general acceptance by the States, the Depart- 
ment's definition should be amended in accordance with our definition. 

Under the heading " Trade Customs," the Lancet makes some very 
proper comments as to the dishonest practices of which many vendors 
and manufacturers are guilty under the convenient designation of 
u trade customs." Our contemporary observes that the term " trade 
customs " in some quarters appears to be the modern synonym for 
malpractices. 

So many defendants shelter themselves, or attempt to shelter themselves, 
behind the plea of trade custom that it would be interesting to have a list of 
" trade customs "• published. 

The public have a right to know what trade customs are. We doubt very 
much if the public know quite as much about them as the trade. Police court 
proceedings enlighten us considerably at times, but there are so many " trade 
customs " that we plead for a glossary of them. We fancy that we should be 
fairly safe in saying that such a compilation would open our eyes to a string 
of petty practices designed more or less to cheat the purchasing public; trade 
customs in fact, which, though approved by the trade, are, strictly speaking, 
illegal transactions. We should like to see appointed a royal commission on 
" trade customs." The selection of the commissioners, who, of course, would be 
authorities on the subject, would be interesting, and the evidence of the wit- 
nesses would at least be amusing if not instructive. The final report would 
have the word " swindle " written in every one of its conclusions — that is to 
say if the commissioners honestly set about their business. These may be 
strong words, but day by day we read in police court proceedings how indict- 
ment after indictment is met by the sickening excuse of " trade customs." 
Brown paper is found in the soles of boots ; it is a trade custom. Silk containing 



294 

cotton is sold as pure silk ; it is a common practice of the trade and therefore a 
justifiable one because the trade recognizes it. It is also at times the trade 
custom to call an article brandy which is not brandy, soda water which is not 
soda water, butter which is not butter, and so on ad Infinitum. In fine, it will 
be found that " trade customs," as a rule, do not call a spade a spade and things 
are not what they seem. The term " trade customs " is a cloak, is not in many 
instances honest, and in an equal number of instances exists to evade the law. 
The law should recognize no trade custom which is not straight dealing. 

The British Food Journal has repeatedly called attention to this 
matter and has indicated the absurdity of the " trade custom " ex- 
cuse. Some of the most insidious forms of swindling are recognized 
and practiced by certain trades under the description of trade cus- 
toms upon which the light of the police court never shines. Those 
'firms who are guilty of such malpractices can well afford to take the 
remote chance of being found out and of having to pay a small fine 
because they find their course of procedure exceedingly remunerative. 
There seems to be an ingrained desire in certain individuals to cheat 
their neighbors and compete by fraud. 

The Horton Ice Cream Company has made the following represen- 
tations respecting the standard: 

Ice cream is a frozen product made from cream and sugar, with or without 
a natural flavor, and contains not less than 14 per cent of butter fat. 

This is the official definition of ice cream according to U. S. Circular No. 19, 
Department of Agriculture. 

If the above is a correct definition of ice cream then for the past fifty years 
and over there has been little or none made and sold. 

Cookbooks dating from 1853 do not describe ice cream in this way and it has 
not been according to American custom to make it in this manner. 

If the authorities will consult the leading and standard cookbooks published 
in this country they will find various ways of making ice cream, and why should 
a law be made where there can be only one way of making it and then only a 
product showing 14 per cent. 

If this standard should be adopted by this State and the United States it 
would fail to bring about the desired effect for the reason that ice cream has 
not been made to show 14 per cent generally, and instead of dealers endeavor- 
ing to comply with the standard ice cream, or what used to be called ice cream, 
would be sold under a new name and in time the term would become obsolete. 
It is no guesswork but a fact that the dealer who attempted to sell standard 14 
per cent goods would not be able to compete with the man who sells what was 
formerly known as ice cream under a new name, either in price or quality, and 
the practical ice cream man knows it. 

There is a market for a frozen product showing less than 14 per cent butter 
fat made with or without eggs, and with or without gelatin, and with or with- 
out condensed milk, and with or without flavor, and time will show it, for 
to-day the leading hotels make an ice cream with eggs and they will not dis- 
continue making this product should they be obliged to change the name, and 
it will be found that this style of ice cream is made by the best men in the 
business and the per cent of butter fat would be found to be about 8 per cent. 

Make a liberal interpretation of the law, say " Ice cream is a frozen product 
made of cream and sugar, with or without milk, condensed milk, gelatin, flavor, 
or eggs, and contains not less than 8 per cent of butter fat," and dealers will 



295 

use their best endeavors to live up to it and see that others do, but if the pro- 
posed standard be adopted dealers can make such fine goods under a different 
name that are equally if not more delicious that ice cream in not many years 
would only be a name. 

These standard cookbooks are not nor were they published to instruct manu- 
facturers how to make their goods, but that housewives might know how to 
make the best of everything, and not with a view of seeing how cheap every- 
thing could be prepared to put before their families. 

Gelatin is just as important an ingredient of ice cream as sugar, for without 
it ice cream could not be sold commercially for the reason that it would get 
icy and not fit to use. 

A very interesting chapter on ice cream is contained in " The Epi- 
curean," by Chas. Ranhofer, chef of Delmonicos, previously quoted. 
In the preface the author says : 

In publishing this work I have endeavored to fill a much-needed want, namely, 
the best and most effectual manner of preparing healthy and nutritious food. 

This edition contains innumerable recipes which I have simplified and ex- 
plained in a comprehensive manner so as to best meet the wants of all. It 
suggests, also, many useful and important hints to those about entering the 
profession. 

Recipe 3451 describes fresh- fruit ice creams which are to be made 
without eggs or cooking. The mixture which is used for the process 
is composed of 3 pints of cream, a pint of milk and a quart of the 
juice of the fruit. Peach ice cream is described as made with two- 
thirds of cream and one-third of the fruit pulp. 

The most important point which is brought out by Mr. Ranhofer 
is the fact that he never uses the words " ice cream " alone to repre- 
sent any of the mixtures which are usually sold under that name. I 
will quote some of the terms which he uses : 

Ice cream al la Cialdini ; Andalusian ice cream chocolate and cocoa ice cream ; 
cinnamon, ginger, or pumpernickel rye bread ice cream ; fresh fruit ice cream ; 
nougat ice cream or nougat Nepolitan cream ; pistachio ice cream ; burnt 
almond ice cream and with angelica ; rice ice cream ; rice ice cream with citron, 
garnished with truffles; Italian meringue; virgin cream with orange flower 
water and noyau; ice cream with almonds; ice cream with eggs and black 
coffee ; ice cream with roasted or boiled chestnuts, etc. 

In all these mixtures into which any extraneous bodies are added 
Mr. Ranhofer is careful to give the name so as to distinguish it from 
the plain term of ice cream. Thus no false idea is conveyed to the 
purchaser respecting its quality or composition. 

THE QUANTITY OF BUTTER FAT IN ICE CREAM. 

The data which have been cited indicate that there is no tendency 
in the trade to secure any uniform quantity or standard of butter fat 
in ice creams. The authorities show that an ice cream may have from 
a mere trace of butter fat up to 17 or 20 per cent. The consumer, 
therefore, has no indication in buying a so-called ice cream of the 
quantity of cream or butter fat which he is about to secure, nor would 
a physician in ordering ice cream for a patient have any information 



296 

of the character of the food that the patient was going to eat ; assum- 
ing that he is getting a genuine ice cream, he may be giving an inva- 
lid a lot of wholly indigestible materials which his stomach in its 
weakened condition would be utterly unable to digest. 

The claim that the manufacture of genuine ice cream will make it 
too expensive for common use does not seem to be based on any reli- 
able data. That real cream sells for more than an imitation and that 
it should sell for more no one will deny. If a man buys two volumes 
of a mixture containing 8 per cent of butter fat as ice cream, he may 
pay no more for it than a man who buys one volume of real ice cream. 
The answer to the question of increased cost would very properly be 
diminished volume. It would surely be advantageous to the con- 
sumer if he put into his stomach a less volume of the frozen mixture 
than he usually does when he buys an ice cream of commerce in which 
water is the chief constituent. 

The claim that the dairies of the country would be unable to fur- 
nish cream for making genuine ice cream is wholly unfounded. The 
dairies of the country are interested as well as the sanitarians in hav- 
ing ice cream pure and true to the name. They will be able to supply 
the legitimate demand for the cream of which the article is made. 

The protests against the standard for butter fat fixed by the Secre- 
tary of Agriculture under authority of Congress, in so far as the 
briefs and arguments which have been offered are concerned, seem to 
be wholly without merit. The same protests were made against 
fixing a legal standard of fat in milk, against the elimination of the 
quantity of water in butter, against the requirements for purity of 
almost every food product. Whenever an attempt is made to fix a 
standard of purity for a food product, all the people who are engaged 
in making a debased article of that kind enter the same kind of a 
plea. There seems to be no basis for a protest of this kind. There 
is no ethical or legal reason why the purchaser of ice cream should 
not have some definite idea of what he is getting. The conditions 
which obtained before the passage of the food and drugs act can not 
be urged in extenuation of their continuance under the pure-food 
act. If this were so there would not be a single abuse which the pure- 
food law was intended to remedy which would not be continued. 
Granted for the moment, as is shown by the data cited, that the term 
ice cream before the enactment of the food law and the establish- 
ment of the standard did not mean anything. Let it be accorded 
that it meant any kind of mixture simulating cream which the com- 
pounder saw fit to make, provided it was sweet enough and flavored 
enough to find a purchaser. These facts do not alter the relations of 
the ice cream to the consumer under the food and drugs act and the 
standards made in harmony with the act of Congress. It is evident 
that under that act every name of a food product was intended to rep- 



297 

resent a certain kind of product and this kind of product is defined 
and established by the standard. Therefore the protests against the 
standard as being too high and oppressive to the consumer and 
impossible of observation by the manufacturer have no basis of fact 
on which to stand. 

A careful study of all the evidence which has been submitted and 
of the authorities leads to the conclusion that ice cream should be 
made of cream, that no other ingredient should be used except the 
sugar and the flavor or fruit, that it should contain not less than 14 
per cent of butter fat where concentrated flavors are used and not 
less than 12 per cent where fruits are used, and with such a defini- 
tion and standard each consumer will know exactly what he buys 
and each manufacturer will know exactly what he shall make. If it 
be desirable to make other frozen puddings, custards, dainties, 
desserts, etc., at the will of the manufacturer, neither the law nor 
the standard raises any objections thereto, but these products should 
be delivered to the consumer under their proper names and not bear 
the name of a standard product on which the physician and the con- 
sumer both rely. 

GENERAL CONCLUSIONS. 

From a careful study of the data which have been collected it is 
evident the following conclusions may be drawn : 

First. The sanitary conditions of many of the localities where ice 
cream is manufactured in the District of Columbia are not at all 
satisfactory. Eadical improvements in such localities are necessary 
to secure purity and freedom from contamination. It is a recognized 
fact that many cases of violent poisoning which arise from eating 
cream or ice cream are due to insanitary conditions surrounding the 
dairy or ice cream factory, the storage for an improper length of time 
of these products, and the contamination which they suffer by reason 
of insanitary conditions by infection from preexisting poisonous 
bodies. The development of ptomaine poisoning in cream and ice 
cream is entirely prevented by using a fresh sanitary raw product, 
manufacturing it in perfectly clean surroundings, and disposing of 
it within a reasonable length of time after manufacture. 

Second. The average percentage of fat in the cream sold com- 
mercially in the District of Columbia is slightly less than that re- 
quired by the statute governing the sale of cream in the District of 
Columbia. It is, however, well within the standard established for 
cream in general by the Secretary of Agriculture. As long as the 
Act of Congress relating to the standard of cream in the District of 
Columbia is on the statute books the dealers should comply with its 
provisions and cream containing less than 20 per cent of butter fat 
should not be sold in the District. 



298 

Third. The bacteriological examination of cream and ice cream in 
the District of Columbia shows that much of it contains a number of 
bacteria which is far in excess of that which should be found in pure 
uncontaminated fresh materials. This enormous bacterial flora is 
due to two causes, namely, insanitary conditions of the dairy and 
factory, and long keeping of the product. From this point of view, 
therefore, a very large percentage of both cream and ice cream sold 
in the District of Columbia is highly objectionable. 

In regard to its content of butter fat the ice cream sold in the 
District of Columbia over the period of time mentioned is fairly 
satisfactory. A very large percentage of all the samples contained 
more than the 14 per cent of butter fat required for the vanilla type 
of ice cream and more than 12 per cent of the butter fat required for 
the fruit type. The establishment of these standards is not sub- 
versive to commercial conditions as they existed at the time examina- 
tions were made. These standards will, therefore, be regarded not 
only as reasonable, but as commercially practicable. 

Fourth. The use of thickeners in the production of ice cream in 
the District of Columbia does not appear to be generally practiced. 
There are many objections to the use of thickeners, the chief of 
which is that it enables an ice cream to be kept a longer period than 
it should be. A confection of the character of ice cream is intended 
for immediate consumption and not for cold storage or long keeping. 
The ice cream industry is essentially a local industry throughout the 
country and there is no commercial necessity of transporting ice 
cream for long distances nor of storing it on board ship, or in other 
localities for a great length of time. The sooner ice cream can be 
consumed after it is made the better. Another objection to the 
thickener is that it aids in the expansion of the volume of cream 
to proportions entirely beyond the actual amount of nourishment 
represented; so that, as has been shown in the evidence, from one 
quart of material two quarts of the product may be produced. Inas- 
much as ice cream is sold quite exclusively by volume and not by 
weight, this expansion can only be regarded as a deception practiced 
upon the consumer. The use of thickeners of any kind in the manu- 
facture of ice cream is not a commercial necessity. When used the 
thickener should be wholesome and unobjectionable from a food 
point of view, and the fact that it has been employed should be 
plainly stated on the label. 

Fifth. The manufacture of frozen dainties containing more or less 
cream is a legitimate industry, provided all the materials used are 
pure and wholesome and no false name or appellation is given to the 
product. A great many products which have been made and sold as 
ice cream belong to this category. Inasmuch as ice cream is pre- 
scribed frequently by physicians for invalids and convalescents, and 
inasmuch as it is largely eaten by children and others whose stomachs 



299 

have not full vigor, a definite idea of its composition is necessary 
to prevent injury and abuse. Hence the term ice cream should be 
reserved solely for the frozen product consisting of pure, fresh cream, 
sugar, and a flavor, while appropriate names should be given to 
other frozen dainties in which more or less cream may enter. The 
use of milk, skimmed milk, and condensed milk in the manufacture 
of ice cream does not appear to be advisable or necessary. These sub- 
stances, when wholesome and pure, are food products of value and 
their use under appropriate appellations is unobjectionable. Con- 
densed milk diluted to its original volume would not be allowed to be 
sold as fresh milk under the laws of any of the States or munici- 
palities controlling the milk supply. There seems to be no ethical 
reason why such products should be permitted to be sold under the 
name of ice cream. They should be offered to the public under appel- 
lations which disclose their real character. 

Sixth. The additional regulations which would secure for the Dis- 
trict of Columbia a supply of ice cream of unobjectionable quality 
should look to the restrictions of the materials used to the pure fresh 
articles. They should require that the butter fat should have a defi- 
nite percentage corresponding to the established standards of 12 and 
14 per cent respectively for the two different types of ice cream. 
They should protect the consumer against an undue expansion of the 
ice cream during the process of manufacture so as to make it occupy 
a volume far larger than is normal. They should restrict the time of 
storage of ice cream to the limit of ordinary needs of consumption. 
They should secure absolute cleanliness and neatness in the dairy and 
in the factory where the ice cream is made. They should exclude 
from ice cream colors not authorized to be put in foods by the rules 
and regulations of the food and drugs act. They should exclude from 
sale ice cream containing a bacterial flora of the enormous proportions 
exhibited by some of the samples which have been examined. By the 
adoption of these sanitary regulations an ice cream of standard qual- 
ity can be offered to the consumers of the District of Columbia, so 
that anyone purchasing the article may know definitely the character 
of the material he is buying, the amount which he gets, and may be 
assured of the freshness and purity of its raw materials and freedom 
from infection during process of manufacture and the time it is kept 
in storage. 

Seventh. The subject of the pasteurization of milk which is to be 
used for making ice cream is an important one and should receive 
careful attention. The data show that cream usually carries a much 
larger number of organisms than milk. This is probably due chiefly 
to the fact that the bacteria seem to stick with greater tenacity to the 
globules of fat than they do to the other parts of the milk. Cream is 



300 

also often kept longer before being used than milk. The pasteuriza- 
tion, to be effective, should be a thorough one, and the cream pasteur- 
ized should be held at the pasteurizing temperature for not less than 
twenty or twenty-five minutes to insure completion. The ideal cream, 
of course, is that derived from ideal milk, handled in an ideal man- 
ner and used in the shortest possible time in its natural state. Since 
in the present condition of affairs, however, it is not possible to secure 
such cream, thorough pasteurization under competent supervision is 
highly desirable. 

Table III. — Chemical, microscopical, and bacteriological examinations of cream from 
January 30, 1907, to June 12, 1907. 



Date. 



Serial 
No. 



Fat. 



Fat 

above(+) 

or below 

(-)18 

per cent. 



Artificial 
color. 



Bacterial 
count 
per cc. 



Streptococ- 
cus. 



Gas produc- 
tion. 



Leuco- 
cytes. 



1907. 
Mar. 27 
May 1 
May 3 
Feb. 27 
Mar. 1 
Mar. 12 
May 27 
Mar. 1 
Apr. 10 
Mar. 2 
May 27 
Mar. 7 
Mar. 11 
Apr. 2 
Apr. 22 
Feb. 20 
May 22 
Mar. 14 
Mar. 25 
June 12 
May 27 
June 11 
Feb. 26 
Mar. 2 
Mar. 8 
Mar. 23 
Jan. 30 
Feb. 1 
Feb. 4 
Mar. 20 
June 11 
Mar. 6 
Do... 
Apr. 19 
May 25 
Feb. 18 
Feb. 20 



M4594 
M4824 
M4829 
M4447 
M4452 
M4511 
M4952 
M4454 
M4680 
M 4459 
M4956 
M4480 
M4495 
M4634 
M4766 
a M 4391 
M 4912 
M4520 
M4579 

B.C. 31 
M4959 

B. C 23 
M 4434 
M 4462 
M 4484 
M4565 
M4328 
M4330 
M4339 
M4548 

B.C. 19 
M4471 
M4472 
M4747 
M4951 
M4381 
M4387 



Per ct. 
18.76 
22.27 
23.16 
16.60 
18.68 
17.67 
18.88 
22.00 
13.10 
15.07 
21.38 
30.00 
21.00 
21.82 
18.32 
42.43 
27.77 
19.19 
18.77 
20.55 
16.31 
24.92 
20.55 
20.82 
19.13 
18.56 
12.60 
12.90 
12.60 
22.31 
21.66 
22.75 
21.95 
15.42 
20.08 
17.58 
16.81 



Colored . . . 
....do.... 
....do.... 



145,000 

15,250,000 

1,050,000 

57, 600 

294,330 

395,000 

52,500,000 

1,175,000 

1,987,500 

458,330 

29,500,000 

2,833,000 

862,500 

113,000 

12,500,000 

1,610,000 

78,300 

161,000 

323,750 

29,500,000 

6,825,000 

15,500,000 

192, 500 

271, 660 

200,000 

8,375,000 

171,830 

938,300 

354,800 

136,000 

155,000,000 

245,830 

288, 300 

99,000 

25,600 

8,050,000 

296, 660 



No 


No 


do 


do 


do 

Few 

do 


Bubble 

1 percent... 
No 


do 


do... 


No 


10 per cent.. 
No 


Few 


do 

Few 


1 percent... 
No 


Many 

do 

do 

No 


10 per cent. . 

2 per cent. . . 
12 per cent. . 

3 percent... 


do 

Few 


5 percent... 
do 


No 


No 


do 


do 


do 


do 


Few 

No 


2 percent... 
10 per cent.. 
2 percent... 
No 


do 

do 


Few 


5 per cent... 

No.. . 


.do .. 


do 


do 




Not det 


Few 


do 


do 

do 


do 

No 


Many 

Few 


10 per cent.. 
do 


do 


No 


No 


Bubble 


do 

do 


15 per cent.. 
No 


Few 


do 



90, 600 

121,900 

223, 100 

1,672,300 

1,057,200 

703,300 

486,200 

1,811,500 

386,300 

21,900 

22,600 

78,600 

33,300 

16,000 

57,900 

22,600 

46,600 

35,300 

59,300 

60,600 

79,300 

258,900 

228, 400 

77,200 

57, 300 

337, 500 

465, 400. 

403,000 

978, 300 

1, 226, 000 

113, 200 

111, 900 

43,300 

56,600 

159, 100 

318,300 



a Double cream excluded from average. 



6 Cloudy, impossible to count. 



301 

Table III. — Chemical, microscopical, and bacteriological examinations of cream from 
January 30, 1907, to June 12, 1907— Continued. 



Serial 
No. 


Fat. 




Per ct. 


M4804 


16.95 


B. C. 33 


18.19 


M4383 


19.45 


M4393 


20.42 


M4616 


19.17 


M4822 


17.20 


M4979 


17.58 


M4716 


16.63 


M4780 


18.33 


M4930 


17.43 


M4540 


19.94 


M4777 


41.75 


M4448 


18.25 


M4567 


19.06 


M4581 


18.02 


M4666 


20.50 


M4813 


23.80 


M4500 


14.04 


M4799 


24.16 


M4531 


20.96 


M4554 


18.97 


M4721 


23.17 


B.C. 34 


20.06 


M4498 


18.02 


M4502 


17.95 


M4512 


18.21 


M4559 


19.16 


M4528 


19.18 


M4543 


20.92 


M4628 


21.50 


M4806 


14.91 


M4827 


23.56 


M4593 


15.90 


M 4536 


16.18 


M4949 


22.33 


M4524 


16.95 


M4533 


16.84 


M4575 


17.46 


M4429 


17.00 


M4446 


15.97 


M4758 


15.84 


M4928 


18.08 


M4366 


15.25 


M4487 


17.00 


M4629 


17.19 


M4768 


20.02 


M4976 


18.38 


M4426 


18.02 


M4464 


23.70 



Fat 
above 

(+) or 
below 
(-)18 

per cent. 



Artificial 
color. 



Bacterial 
count 
per cc. 



Streptococ- 
cus. 



Gas produc- 
tion. 



Leuco- 
cytes. 



753, 300 



Free. 



Colored.. 



46,166,000 

4,400,000 

4,825,000 

320,800 

9,250,000 

9,750,000 

425, 000 

575,000 

28,900,000 

1,375,000 

2,066,600 

70,400,000 

161,000 

2,087,500 

30,500,000 

180,000 

309,000,000 

516,000 

3,350,000 

29,000,000 

1,177,500 

359,960 

350,830 

397,500 

P) 

90,000 

12,000 

593,000 

59,500,000 

700, 000 

5,400,000 

54,000,000 

151,600 

1,450,000 

1,520,800 

755,860 

180,000 

208,000 

61,000 

625,000 

21,216,000 

275,000 

537,500 

17,500,000 

26,000,000 

350,830 

1,183,000 



No 



No 

Many 

.....do 

Few 

No , 

do 

Few 

No 

Many 

No 

Many 

Few 

Many 

do 

Few.. 

No 

Few 

No 

do 

do 

Few 

do 

No 

Many 

No , 

Few 

No 

Few 

No , 

do 

Many 

Few 

No , 

do 

Many 

Few 

No , 

Very many 

No 

do 

Numerous . . 

Many 

No 

.....do 

do 

do 

Few 



No 

do 

do 

do 

do 

27 per cent.. 
25 per cent.. 
4 percent... 
No 

1 percent... 

17 percent.. 

No 

Bubble 

40 per cent.. 

2 per cent . . . 
No 

3 per cent... 
No 

do 

do 

do...... 

Bubble 

No 

do 

do 

do 

do 

10 percent.. 

Bubble 

No 

do 

do 

25 per cent.. 

No 

do 

Bubble 

No 

12 per cent.. 
10 per cent.. 
6 percent... 

18 percent.. 

3 per cent... 

4 per cent. . . 
3 per cent... 
25 per cent.. 
15 per cent.. 
8 percent... 



126, 500 

127, 900 

654, 000 

113, 900 

3, 565, 300 

968, 400 

2, 186, 600 

1,837,300 

4,082,600 

2, 534, 600 

130,500 

70,600 

156, 100 

121,200 

309,000 

219, 100 

57,300 

1,262,000 

(a) 

41,300 

44, 600 

6,000 

29,300 

57,300 

23,900 

75,900 

57,900 

39,300 

35,300 

1,374,000 

1, 356, 600 

1,094,600 

36,600 

73,200 

22,600 

32, 600 

217, 100 

145,800 

148,600 

58,900 

163,800 

180, 500 

361,800 

561,400 

2,237,300 

321,000 

583,400 

2,446,000 

1,796,800 



a Too badly coagulated to count. 



Not determined. 



302 

Table III. — Chemical, microscopical, and bacteriological examinations of cream from 
January 30, 1907, to June 12, 1907— Continued. 



Date. 



1907. 
Feb. 15 
Feb. 20 
Mar. 13 
May 27 
Feb. 15 
Mar. 12 
Mar. 19 
May 18 
May 25 
Feb. 6 
Do... 
Feb. 8 
Feb. 9 
Feb. 20 
Apr. 24 
May 24 
Feb. 20 
Mar. 1 
Mar. 15 
June 12 
Feb. 26 
Apr. 20 
May 28 
Feb. 4 
Feb. 5 
Feb. 6 
Mar. 5 
Mar. 6 
Mar. 9 
Mar. 13 
Apr. 3 
May 27 
Feb. 16 
Feb. 18 
Feb. 20 
Apr. 15 
May 27 
Feb. 20 
Apr. 1 
Feb. 26 
Apr. 8 
Apr. 16 
May 28 
Mar. 27 
Apr. 3 
May 1 
May 29 



Serial 
No. 



M4372 
M4388 
M4514 
M4958 
M4371 
M4509 
M4538 
M4907 
M4948 
M4345 
M4346 
M4350 
M4360 
M4392 
M4784 
M4926 
M4389 
M4451 
M4525 
B. C. 32 
M4428 
M4760 
M4965 
M4337 
M4342 
M4348 
M4465 
M4469 
M4492 
M4517 
M4643 
M4954 
M4377 
M4382 
M4394 
M4723 
M4957 
M4390 
M4624 
M4430 
M4673 
M4729 
M4964 
M4596 
M4639 
M4819 
M4977 



Fat. 



Per ct. 
15.40 
17.29 
17.91 
13.62 
15.25 
20.10 
18.00 
18.10 



Fat 
above 
(+) or 
below 
(-)18 
per cent, 



Artificial 
color. 



Bacterial 
count 
per cc. 



Colored . 
...do... 
...do... 
...do... 
...do... 
...do... 
...do... 



Colored . 
....do.. 
....do.. 
....do.. 



1, 408, 330 

159, 330 

175,000 

20,500,000 

1,888,330 

200, 000 

6,675,000 

40,500,000 

18,000,000 

262,000 

631, 660 

260,000 

222, 660 

150,160 

2,825,000 

1,300,000 

16,966,000 

43, 600, 000 

87,000 



Streptococ- 
cus. 



2, 123, 300 

50,500,000 

11,150,000 

560, 330 

930,000 

9,116,000 

2,041,600 

2,841,600 

1,070,830 

543, 300 

4,300,000 

26, 500, 000 

262, 330 

202, 350 

269, 330 

126, 600 

11,500,000 

14,933,000 

14,000,000 

16, 966, 000 

7,250,000 

725,000 

15, 500, 000 

5,800,000 

27,000 

61,500,000 

64,000,000 



Many 

Few 

do... 

No 

Many 

No 

Many 

No 

Few 

No 

Few 

do... 

Very few 

No 

do... 

do... 

Many 

....do... 
No 



Gas produc- 
tion. 



Very many 

Few 

No 

Many 

Numerous. 

Few 

Many 

do 

Few 

Many 

No.: 

Few 

No 

do 

do 

do 

do 

Very few . . . 

Many 

do 

Few 

No 

do 

Few 

No 

do 

Few 



12 percent. 
No 

do 

40 per cent. 
4 per cent.. 

No 

do 

3 per cent.. 
20 per cent. 
12 percent. 
2 percent.. 

No 

do 

do 

do 

8 percent.. 

No 

17 per cent. 
No 



2 percent.. 
No 

45 per cent . 
Notdet.... 
12 percent. 
40 per cent. 
15 per cent. 
10 per cent. 

No 

do 

do 

28 percent. 

No 

....do 

....do 

4 per cent.. 
12 per cent . 

3 per cent.. 

No 

4 per cent.. 

5 per cent.. 
3 per cent. . 
30 per cent. 
5 per cent.. 

No 

15 per cent. 
20 percent. 



303 



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10. THE CHEMISTRY OF MILK. 



(313) 



THE CHEMISTRY OF MILK. 



By Joseph H. Kastle, Chief Division of Chemistry ; and Norman Roberts, 
Passed Assistant Surgeon, Public Health and Marine-Hospital Service. 



PREFACE. 



In the following pages the attempt has been made to present suc- 
cinctly and yet sufficiently comprehensively for a thorough under- 
standing of the subject what is known to-day regarding the chemistry 
of milk, and to give the results of the analyses of the Washington 
milk supply, made in the division of chemistry of the hygienic labora- 
tory during a period of twelve weeks extending through July, August, 
and September, 1907. 

Part I of this communication deals with the chemical composition 
and general characteristics of milk. 

Part II deals with the chemical changes occurring in milk. Under 
this head are included changes in the composition of milk brought 
about, (1) by the action of heat and acids, (2) by the action of the 
enzymes of milk, (3) by the action of the digestive ferments, (4) 
by the action of bacteria and other micro-organisms, including the 
lactic acid fermentation and the abnormal fermentations of milk. 
Under this last section a few pages are also devoted to the subject of 
poisoning by milk, galactotoxismus. Under section 1 the destructive 
effect of heat on the milk enzymes is also considered. 

Part III is devoted to the consideration of legal standards govern- 
ing the sale of milk in various localities. 

Part IV is devoted to the subject of milk adulteration, by skim- 
ming, watering, and the addition of foreign substances, including 
artificial coloring matters and milk preservatives. Some attention 
has been paid to the effect of artificial coloring matters and preserva- 
tives on the health of man. 

Part V is devoted to the general consideration of the Washington 
milk supply. Under this head will be found, (1) a brief outline of 
the methods employed in milk analysis, (2) the results of our analyses 
of the Washington milk supply, (3) conclusions regarding the general 
character of the Washington milk supply. 

(315) 



316 

In the preparation of this communication we have drawn freely 
from the writings of numerous authors on the subjects herein con- 
sidered. In every instance the attempt has been made to give due 
credit to all concerned and no special credit is claimed for any orig- 
inality in the treatment of any of the subjects herein presented. 
Free use has been made of many treatises and works on the subject 
of milk and milk analysis and of many original articles and mono- 
graphs treating of the composition of milk, the rennin coagulation, 
the milk ferments, the use of coloring matters and preservatives and 
their possible injurious effects. For all of these due acknowledg- 
ment is hereby made. To Conn, "Agricultural Bacteriology," Phila- 
delphia, 1901, we are especially indebted for much on the subject of 
the abnormal fermentations of milk. To Leach, " Food Inspection 
and Analysis," New York, 1907, and to Van Slyke, "Modern Methods 
of Testing Milk and Milk Products," New York and London, 1907, 
for methods pertaining to milk analysis, and for valuable data on the 
composition of milk and milk adulteration. To the health office of 
the District of Columbia we are indebted for much assistance during 
the progress of the work, and to Prof. Victor C. Vaughan, of the 
University of Michigan, for private information relative to recent 
progress in the field of milk poisons. 

PART I.— THE COMPOSITION AND GENERAL CHARACTERISTICS OE 

MILK. 

Milk is the specific secretion of the mammary glands. a The milk 
of a number of animals has been and is still very extensively used 
as food by man. The milk of different animals shows a general 
agreement in physical properties and composition, containing essen- 
tially the same ingredients but exhibiting differences in the amounts 
of the several constituents. Of all the different kinds of milk, that 
of the cow is the most universally used, and in what follows, unless 
expressly stated to the contrary, it will be understood that cow's milk 
is meant whenever the term " milk " is employed. 

In the perfectly fresh state, milk is a yellowish-white, opaque fluid. 
When allowed to stand undisturbed for some time it separates into 
two distinct layers. The upper, lighter layer, occupying a smaller 
volume than the lower, heavier layer, is what is called " cream," and 
consists largely of globules of fat. The lower, heavier layer, white 

a Ordinarily milk is secreted by the female mammal only, and only after par- 
turition. In some instances, however, the mammae of newborn children, males 
as well as females, also secrete small amounts of a milk-like fluid known as 
witch's milk; and still more rarely milk is said to have been secreted by the 
mammary glands of the adult human male. Fluids resembling milk are also 
formed in certain pathological conditions. All of these instances are, however, 
more or less rare and warrant no further consideration in this connection. Milk- 
like secretions of vegetable origin are also not considered in this communication. 



317 

or bluish white in color, is when separated known as " skim milk." 
On account of changes due to the growth and action of micro-organ- 
isms the color of the milk may be altered; for example, it has been 
found under certain conditions to become red, blue, yellow, etc. As 
is well known, milk when fresh possesses a distinctly sweet taste and 
a characteristic odor. It is heavier than water, the specific gravity 
of cow's milk ranging from 1.027 to 1.035. It freezes at a tempera- 
ture somewhat lower than the freezing point of water — according to 
Beckmann (1), at —0.554° C. Atkins (2) has also found the freez- 
ing point of milk to be practically constant, viz, —0.55° C., the varia- 
tions from this mean value rarely exceeding 0.03° C. 

On account of the presence of dissolved salts of various kinds, milk 
conducts the electric current. Koeppe (3) found the electrical con- 
ductivity of cow's milk to be 43.8. 10- 4 and that of human milk to be 
22.6. 10- 4 . He concludes therefore that in cow's milk 0.072 and in 
human milk 0.04 grammolecules (Molen) exist in the ionic condition, 
or, in other words, that in cow's milk 58 per cent and in human milk 
26 per cent of the molecules are dissociated. 

The specific heat of milk has been determined by Fleischmann (4). 
For milk containing 3.17 per cent of fat he finds the specific heat to 
be 0.9457. This same author also determined the coefficient of 
expansion of milk by heat and found it between 5° and 15° C. to be 
greater than that of water. According to Fleischmann (5) milk 
shows no maximum of density above 1° C. 

The viscosity of milk has been determined by Soxhlet (6) using a 
Reischauer viscosimeter. The following are the ratios of the inter- 
vals required for the delivery of the same volume of water and milk 
at different temperatures: 



Temperature. 


Ratio of 

water 

to milk. 


Temperature. 


Ratio of 

water 

to milk. 


0° c 


100 : 221.1 
100 : 207.7 
100 : 190.6 
100 : 188.7 


20° C 


100 : 211.7 


5° C 


25° C 


100 : 175.9 


10° c 


30° C 


100:169.0 


15° C 











The microscopic examination of milk reveals the presence of great 
numbers of fat globules, and according to Cohn (7) and also Savage 
(8) the presence also of leucocytes and streptococci derived from the 
udder of the cow. (For further information on this subject see 
article 13 of this bulletin, " The significance of leucocytes and strep- 
tococci in milk," by W. W. Miller.) 

Lawrence (79) has recently observed an instance of the appearance 
of typhoid bacilli in the milk of a nursing woman ill with typhoid 
fever. 



318 

With the higher powers of the microscope various forms of bacteria 
can be distinguished, some of which at least play an important part 
in the changes which take place when milk is kept for some time at 
ordinary temperatures. The perfectly fresh milk of carnivorous 
animals is as a rule acid in reaction. According to Leach (9) the 
acidity of fresh milk is due to carbon dioxide and acid phosphates, 
and according to Richmond (10) to mono- and di-phosphates. 
Human milk and that of herbivora is slightly alkaline and cow's 
milk has been described as amphoteric; that is, it is alkaline to red 
litmus, acid to blue litmus. Vogel (11) states that he has never yet 
found perfectly freshly drawn cow's milk to show a decidedly alka- 
line reaction to litmus. In the greater number of instances the reac- 
tion of freshly drawn milk was either neutral or transiently acid. On 
standing exposed to the air for some time all forms of milk become 
more or less acid in reaction in consequence of the conversion of milk 
sugar into lactic and other acids by the action of various micro-organ- 
isms, until finally considerable amounts of acid are produced, which 
are responsible for the souring and curdling of the milk ordinarily 
observed. 

For further information relative to the reaction of human and 
cow's milk and for a theoretical explanation of the acidity and 
alkalinity shown by these milks, see Courant, pp. 349-350. 

Milk consists chiefly of water. In addition to this it contains fat, 
•lactose, several proteids (see Halliburton (12)), such as caseinogen, 
lactalbumin, lactoglobulin, opalisin, and lactomucin, and a number of 
salts. It also contains certain dissolved gases, such as oxygen, nitro- 
gen, and carbon dioxide. The oxygen and nitrogen are carried into 
the milk mechanically in the process of milking. Carbon dioxide is 
present in milk to the extent of 3 or 4 per cent by volume and partly 
escapes into the air when milk is drawn from the udder. Besides the 
substances already mentioned still others have been found in milk 
in small quantities. Among these may be mentioned lecithin (13), 
cholesterol (14), citric acid (15), lactosin, a new carbohydrate 
(16), and orotic acid (17). This substance has the composition 
C 5 H 4 4 N 2 .H 2 0, and is believed by its discoverers to have the con- 
stitution : 

NH.CH 2 .CO NH. CO.CH 2 

CO< | orCO< | 

NH.CO.CO NH.CO.CO. 

Sherman, Berg, Cohen, and Whitman (18) found small amounts of 
ammonia in fresh milk. According to Trillat and Sauton (19) the 
presence of ammonia in fresh milk is usually indicative of contamina- 
tion. According to Schondorf (20) human milk contains small 
amounts of urea. Jolles (21) and others have called attention to 
the relatively large amounts of iron which woman's milk normally 



319 

contains, and to its influence on the health of the child. Camerer 
(22) found 21 milligrams of iron oxid in 100 cubic centimeters of 
human milk from the third to the twelfth day of lactation. Accord- 
ing to Jolles and Fried jung (23) the quantity of iron in human milk 
decreases with bad environment and poor condition of the mother. 

In certain diseased conditions milk may contain still other sub- 
stances not ordinarily present in the milk of healthy animals. For 
example, Van der Marck (24) has detected bile in the milk of a 
woman who had developed jaundice after confinement, and Des- 
moulieres and Gautrelet (25) have found that the so-called lipo- 
chrome of cow's milk consists almost entirely of urobilin. Still other 
substances are sometimes acquired by milk either from the food of 
the animal or from its environment after its removal from the animal. 
Bordas and Touplain (26) have shown for example that milk rapidly 
absorbs certain odoriferous substances from the air, and Dombrowski 
(27) has shown that the odor and flavor of certain seeds and plants 
are imparted to the milk by feeding with these substances. An 
excellent example of this is furnished in the case of garlic. Ac- 
cording to Rosemann (28) alcohol passes into the milk when admin- 
stered to an animal in large amounts. Similarly Teichert (29) ob- 
served that the milk of cows fed 90 per cent " slump " contained fusel 
oil and that calves fed with such milk died. According to Bechamp 
(30) even freshly drawn milk contains recognizable amounts of 
alcohol and acetic acid. Golding and Feilmann (31) detected copper 
in a certain milk supply, and have shown that in the presence of air 
milk has the power of dissolving small quantities of this metal. 

In addition to the substances already mentioned, normal milk con- 
tains a number of enzymes, such as diastase (amylase), galactase, 
lipase, catalase, peroxidase, reductase, etc. The presence of these 
ferments serves to distinguish raw from boiled milk. According to 
Marfan and Gillet (32) milk is not an inactive fluid, but possesses 
certain properties peculiar to living substances. According to these 
authors it contains ferments and gives Bordet's reaction (see p. 335), 
which reaction is not shown by dead material. It also shows Moro's 
reaction (see p. 335). These specific ferments of milk and its char- 
acteristic biochemical reactions will be considered at length under 
milk enzymes (see pp. 335 to 342). 

Woodhead and Mitchell (33) have recently shown that milk also 
contains opsonins in even greater quantity than blood serum. It 
also contains alexins and bactericidal substances. According to 
Brieger (34) and his coworkers, the milk of animals immunized 
against diphtheria and tetanus contains antitoxins. 

A very good idea of the quantities of the several more important 
substances contained in milk may be obtained from the following 
schemes compiled by Lucius L. Van Slyke (35) and S. M. Babcock 
(36): 



320 







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321 

According to Farmers' Bulletin No. 29, United States Department 
of Agriculture (37), 1895, cow's milk has the following composition: 

Per cent. 

Water =87 87. o 

iFat =3. 6 3. 6 

Solids not fat =9.4p^ em : ?'? 

I Albumin 0.7 

~J Milk sugar 4.7 

13 -°Ush 0.7 

100.0 

Van Slyke (38) gives the following average analysis of cow's milk: 





Water. 


Total 
solids. 


Fat. 


Casein. 


Albu- 
min. 


Sugar. 


Ash. 


Average of 5,552 American analyses compiled by- 


87.1 
87.4 


12.9 
12.6 


3.9 
3.75 


2.5 
2.45 


0.7 
0.7 


5.1 
5.0 


0.7 


Average cbeese-factory milk for the season (May 


0.7 







The following compilation, according to Leach (39) from Koenig's 
Chemie der menschlichen Nahrungs- und Genussmittel, gives a very 
good idea of the composition of human milk and that of a number of 
different animals: 



Num- 
ber of 
analy- 
ses. 



800 



200 



32 



Kind of milk. 



Cow's milk: 

Minimum . 
, Maximum . 

Mean 

Human milk: 

Minimum . 

Maximum . 

Mean 

Goat's milk: 

Minimum . 

Maximum . 

Mean 

Ewe's milk: 

Minimum . 

Maximum . 

Mean 

Mare's milk: 

Mean 

Ass's milk: 

Mean 



Specific 
gravity. 



1. 0264 
1.0370 
1.0315 

1. 0270 
1. 0320 



1. 0280 
1.0360 
1. 0305 

1. 0298 
1. 0385 
1.0341 

1.0347 

1. 0360 



Water. 



80.32 
90.32 

87.27 

81.09 
91.40 
87.41 

82.02 
90.16 

85.71 

74.47 
87.02 
80.82 

90.78 

89.64 



Casein. 



1.79 
6.29 
3.02 

0.18 
1.96 
1.03 

2.44 
3.94 
3.20 

3.59 
5.69 
4.97 

1.24 

0.67 



Albu- 
min. 



0.25 
1.44 
0.53 

0.32 
2.36 
1.26 

0.78 
2.01 
1.09 

0.83 

1.77 
1.55 

0.75 

1.55 



Total 
proteids. 



2.07 
6.40 
3.55 

0.69 
4.70 
2.29 



I. '29 



6.52 
1.99 
2.22 



Fat. 



1.67 

6.47 
3.64 

1.43 
6.83 

3.78 

3.10 
7.55 
4.78 

2.81 
9.80 
6.86 

1.21 

1.64 



Milk 
sugar. 



2.11 

6.12 

4.88 

3.88 
8.34 
6.21 

3.26 
5.77 
4.46 

2.76 
7.95 
4.91 

5.67 

5.99 



Ash. 



0.35 
1.21 
0.71 

0.12 
1.90 
0.31 

0.39 
1.06 
0.76 

0.13 
1.72 
0.89 

0.35 

0.51 



45276°— Bull. 56—12- 



-21 



322 

Bunge (40) gives the following table showing the results of analy- 
ses of the milks of a number of different animals : 
One hundred parts of milk contain — 





Human. 


Dog. 


Cat. 


Rab- 
bit. 


Guinea 
Pig- 


Sow. 


Ele- 




I. 


II. 


III. 


phant. 






1.2 
0.5 
1.7 
3.8 
6.0 
0.2 


1.5 
3.3 
6.5 
0.3 


5.2 
1.9 
7.1 
12.5 
3.5 
1.3 


3.1 
6.4 
9.5 
3.3 
4.9 
0.6 
























1.7 
3.1 
5.9 
0.2 


15.5 

10.5 

2.0 

2.6 


11.2 

45.8 

1.3 

0.6 


5.9 
6.9 
3.8 
1.1 


3.1 


Fat 


19.6 




8.8 


Ash 


0.7 








Horse. 


Ass. 


Cow. 


Goat. 


Sheep. 


Rein- 
deer. 


Camel. 


Llama. 


Por- 
poise. 


Casein 


1.2 
0.8 
2.0 


0.7 
1.6 
2.2 
1.6 
6.0 
0.5 


3.0 
0.5 
3.5 
3.7 
4.9 
0.7 


3.2 
1.1 
4.3 
4.8 
4.5 
0.8 


5.0 
1.6 
6.5 
6.9 
4.9 
0.9 


8.4 
2.0 
10.4 
17.1 
2.8 
1.5 




3.0 
0.9 
3.9 
3.2 
5.6 
0.8 










Total proteids 


4.0 
3.1 
5.6 

0.8 


a 7. 6 


Faf 

Sugar 

Ash 


1.2 

5.7 
0.4 


43.8 
0.5 



a Proteids and sugar of milk. 

He calls attention to the extreme variability in the composition 
of the milk of different animals. The large amount of fat contained 
in some of these milks is certainly very striking. On the other hand, 
the milks of most of these species show a reasonable similarity so 
far as the amounts of the several constituents are concerned. 

H. Droop Richmond (41) has made a very large number of analy- 
ses of milks sold in England. As a rule he found the average com- 
position of the milks produced in that country to be considerably in 
excess of the legal requirements. The following table will give some 
idea of the results of his analyses for a number of years : 



Year. 


Number 
of milks 
analyzed. 


Total 
solids. 


Fat. 


Year. 


Number 
of milks 
analyzed. 


Total 
solids. 


Fat. 


1900 


13, 798 
13, 936 

12, 914 
15, 313 


12.57 
12.63 
12.73 
12.78 


3.64 
3.72 

3.82 
3.83 


1904 


15, 910 
14,828 


12.68 
12.70 
12.64 


3.74 


1901 


1905 


3.73 


1902 


1906 


3.71 


1903 













This author (42) also gives a single analysis of woman's milk and 
that of a she ass, which are worthy of record in this connection : 



Kind of milk. 


Total 
solids. 


Fat. 


Sugar. 


Proteids. 


Ash. 


Solids 
not fat. 


Acidity. 




10.27 
13.97 


1.45 
5.61 


5.65 
6.98 


2.09 
1.27 


0.54 
0.18 


(8. 82) 
8.36 


0.54 


Woman's milk 









323 

Billitz (43) gives the following results of the analyses of 187,610 
specimens of milk produced in Lombardy during the years 1892 to 
1902: 

Specific gravity 1. 0315 

Fat— 3. 55 

Solids not fat 8.81 

The poorest milk from a herd of 50 cows gave the following 
numbers : 

Specific gravity 1. 0306 

Fat 2. 70 

Solids not fat " 8.45 

The richest milk from a herd of 80 cows gave the following : 

Specific gravity 1. 0326 

Fat 4. 10 

Solids not fat 9.23 

These figures suffice to give an idea of the average composition of 

milk. 

On the other hand cow's milk is liable to extreme variations in 

composition. For example, Cook and Hills (44) have recorded the 

following analysis of the milk of a Jersey cow just before she went 

dry: 

Total solids 28. 43 

Fat 14. 67 

Solids not fat 13.76 

Casein and albumin 9.98 

Milk sugar 2.33 

Ash 1. 44 

This milk is remarkable for the large amounts of fat, proteid, and 
ash, and for the small amount of milk sugar. According to these 
authors there seems to be no other record of a milk showing more 
fat than solids not fat. On the other hand Wanters (45) has recorded 
analyses of several milks showing very small amounts of fat and 
nonfatty solids: 



Fat. 



Solids not fat. 



(a) 
(6) 



1. 319 to 2. 575 
1.250 to 2. 965 



5. 031 to 7. 635 
6.19 to8.0S5 



The ash of these milks was abnormally high. 

Janke (46) also reports the results of analyses of certain samples 
of milk supplied the city of Bremen. The samples were taken in 
the presence of a police officer and are remarkable for the small 



324 

amounts of total solids and fat which they contained. His results 
are as follows: 



Total 
solids. 



Fat. 



(a). 

(6) 
(c). 



7.71 
6.80 
8.23 



0.868 
.633 
.416 



Out of another lot of 103 samples analyzed by this chemist (47), 
the poorest milk had a specific gravity of 1.0275 and contained 9.04 
per cent total solids and 1.60 per cent of fat. 

The composition and also the yield of milk have been found to 
vary with the seasons of the year, with the character of the food, 
with the condition of the animal, and also whether it is fatigued or 
at work or at rest. It is also subject to some diurnal variation 
(Richmond (48)). It is also influenced by the addition of certain 
stimulants and nitrogenous compounds to the food. It also varies 
in composition during the course of lactation and also at different 
stages of the same milking. Sherman (49) has shown by monthly 
analyses extending over two years on a herd of 600 cows that the 
per cent of proteids in milk and likewise the fat varies with the 
season, being higher in autumn and winter than in the spring or 
summer. On the other hand the percentage of lactose remains prac- 
tically constant throughout the year. Richmond (50) also found 
the lowest percentage of fat in May and June and the highest during 
the winter months. On the other hand he found that the geology 
of the region over which the herd grazed exerted but little influence 
on the composition of the milk. 

Concerning the effect of food on the composition of milk, there 
seems to be a good deal of difference of opinion among different in- 
vestigators, some holding that the character of the food exerts a 
great influence on the character of the milk, others maintaining that 
this influence is but slight if any. According to Albert and 
Maercker (51) rations rich in fat cause a decided increase in the fat 
of the milk. If this however be continued for long intervals the 
fat falls to its original amount with the poorer rations. Rhodin (52) 
found that emulsified oils cause an increase in the amount of fat, 
followed by a return to the normal amount. These observations 
were confirmed by Bartlet (53). 

Gogitidse (54) found that by feeding sheep with linseed oil the fat 
of the milk could be made to contain as much as 33 per cent of lin- 
seed fat. Hills (55) observed that the addition of cotton seed, maize, 
or linseed oils to the food of cattle tends to increase the yield of milk 
per unit of dry matter fed. With cotton-seed oil there seemed to be a 



325 

fairly permanent increase of 0.2 to 0.3 per cent of fat in the milk. 
On the other hand maize and linseed oils, when given as a regular 
diet, while causing a marked increase in the fat at first, seemed to 
lower the percentage of fat in the later stages of the experiment. 
Essentially similar results have been obtained by V. Henriques and 
Hansen (56). Sebelien (57) has found that the effect of feeding 
whale meal was to increase the yield of milk 6 per cent during the 
period when it was given. There was no after effect. The absolute 
amount of fat was increased during the first period of whale-meal 
feeding, but sank during the last period to the amount produced in 
the preliminary period. The percentage of fat was not altered by the 
whale meal when this was given as additional food, but was lowered 
when an extra quantity of it was given. Wing (58) found that the 
addition of fat to the fodder neither increased the quantity of milk 
nor the amount of fat which it contained. Morgen, Beger, Finger- 
ling, Doll, Hancke, Sieglin, and Zielstorff (59) working together, have 
shown as the result of an extensive series of investigations on the 
effect of foods and food fat on the production of milk and milk fat in 
sheep and goats that food almost free from fat maintained the ani- 
mals in healthy condition and increased the live weight of the 
animal, but that such foods were unsuitable for milk production. Food 
fat in small quantities, 0.5 to 1 gram weight per kilo of the animal 
was found to promote the production of milk fat. They proved fur- 
ther that so far as their effect on milk production and the increase of 
fat in milk is concerned, stimulants are only desirable in certain cases. 
These investigations have been further extended by these observers 
working together or alone. For example, Morgen, Beger, and Fin- 
gerling (60), as the result of studies extending over six years, have 
reached the conclusion that of all foods, fat alone exerts a specific 
action on the production of milk fat, proteids and carbohydrates 
exerting no such action, and that within certain limits fat is the most 
suitable of all foods for milk-fat production. In this same con- 
nection, Finger ling (61) has shown that the replacement of food 
deficient in fat (barley meal) by one containing more fat (rice meal) 
increased both the absolute amount and the percentage of fat in the 
milk. From a study of the influence of stimulants on the consump- 
tion and digestibility of food and the secretion of milk he (62) has also 
arrived at the conclusion that when added to foods entirely free from 
stimulants the effect of the stimulant is to increase the consumption 
of food and the yield of milk and milk constituents. When how- 
ever stimulants are added to foodstuffs already containing such sub- 
stances they are without effect on the yield of milk. He concluded 
therefore that they are of use only in special cases, as, for example, 
when cattle are fed with hay. In such cases the addition of such 
materials to the food as fenugreek, anise, and caraway seed is to be 



326 

recommended. According to Temesvary (63) beer increases the 
amount of milk fat. Morgen, Beger, and Fingerling (64) have also 
investigated the influence of fat and other substances on milk produc- 
tion when fed in connection with a scanty basal meal. They have 
observed an increase in the yield of milk and an increase in the per- 
centage of fat amounting to 0.14 per cent when such quantities of fat 
were added to the food. The addition of large quantities of fat to the 
food caused a further increase in the yield of milk, but was found to 
vary in its effect on milk-fat production, sometimes causing an in- 
crease, sometimes a decrease. Caspari (65) has shown that iodized 
fats appear in the milk even though the food be poor in fats and 
rich in carbohydrates. He therefore concludes that some of the 
fat of milk comes from the fat of the food. Later (66) he showed 
that when iodocasein and iodoalbumin are fed to an animal no traces 
of iodized fats appear in the milk. On the other hand there are 
those who hold that the addition of fat to food does not increase the 
quantity of fat in milk and that there is no direct migration at least 
of the fat of the food to the milk. Such a conclusion was arrived at 
by Einecke (67) from his experiments with goats. With liberal com- 
prehensive rations the yield of milk and fat depends, according to 
this observer, on the individuality of the animal. The milk from 
cows grazing off the poor, dried-up grass on the plateau of Setif, in 
Algeria, has been compared by Malmejac (68) with that of cows fed 
on rich forage with the following results : 





Poor dry grass. 


Rich forage. 




11. 62 to 14. 25 
3. 33 to 3.50 
3. 13 to 4.46 
4. 53 to 5.64 
0.60 to 0.90 


13. 76 to 14. 90 


Fat 


4. 05 to 4.90 


Lactose 


3. 33 to 4.54 


Proteids 


4. 47 to 5.55 


Ash 


0.82 to 0.93 







Except for the proteids, the differences in composition are obviously 
in favor of the milk produced on the richer diet. Woll (69) ob- 
served that as a food for milch cows silage increases the yield of milk 
and butter 3 per cent over that produced with maize fodder when the 
area of land required to produce the two foods is taken into account. 
Some studies have also been made of the effects of certain definite 
nitrogen and phosphorus compounds on the production of milk and 
milk fat. Morgen, Berger, and Fingerling (60) have investigated the 
effect of adding lecithin to food. This substance seemed to increase 
the yield of milk and also the live weight of the animal. It was 
found, however, to be favorable to the production of milk fat only 
when it was fed in conjunction with other foods deficient in fat. 
Pfeiffer, Einecke, and Schneider (70) have shown that asparagin 



327 

when substituted for proteids, along with cane sugar, caused no dimi- 
nution in the yield of milk, in fact in some instances it seemed to 
cause an increase, but the amount and percentage of fat in milk was 
diminished. The feeding of this compound also acted unfavorably 
on the increase in live weight, and caused a reduction in the percent- 
age of proteids and dry matter in the milk. Morgen, Beger, and 
Westhauser (71) have reached the conclusion that amino compounds 
can not take the place of proteids in milk production, but that they 
exert a greater effect than carbohydrates. 

It has been observed that the actual yield of milk diminishes in 
the later period of lactation. According to Trunz (72), however, 
the specific gravity of the milk, and most of the solids, including the 
proteids, are relatively increased, while the proportion of albumin 
to casein remains remarkably constant throughout the entire period 
of lactation. This same investigator (73) has also made an exhaust- 
ive study of the mineral constituents of cow's milk and their varia- 
tion during the period of lactation with the result that he has found 
considerable variation in the ash contents during the lactation 
period and that the total quantity of ash varies from time to time 
throughout the period, being as a rule less during the spring and 
summer months than during the autumn and winter months. 

Hardy (74) claims to have shown that the milk of a given cow 
varies in composition at the different stages of milking. Thus 
taking the milk in quantities of one-half liter at a time the milk of 
one cow gave the following successive numbers for fat: 2.2, 2.9, 3.5, 
3.75, 3.8, and 4.65 per cent. The solids rose from 10.52 to 12.70 
and the ash from 0.74 to 0.75 per cent, The composition of the milk 
serum was found to remain the same throughout the milking. 

On the other hand Ackermann (75) claims that the conclusion that 
the fat in milk increases regularly during the process of milking, as 
this is ordinarily carried out, is incorrect. He has found, however, 
that by milking the teats singly or in pairs the fat did show an in- 
crease up to a maximum at the end of the milking and that on draw- 
ing the milk from the second pair of teats the quantity of fat was 
slightly more at the commencement than that given by the first pair 
and rose at the end of the milking to a higher maximum. The in- 
crease is probably due to a mechanical or physiological stimulus. 

The effect of work and fatigue on the quantity and quality of the 
milk has also been studied by several observers. Hills's (76) results 
would seem to show that there is a slight falling off in the quantity 
of milk produced as a result of fatigue, 122.5 pounds against 131.4 
pounds after rest. The total solids and the fat were found to be 
slightly higher during the period of fatigue than after rest. Dornic 
(77) also has shown that the yield of milk is diminished slightly as 
the result of work. The dry matter and the amount of acid were 



328 

slightly increased. It was further observed by this investigator 
that work exerts a harmful influence on the quality of the milk, 
especially on its keeping qualities. For example it was found in 
the case of a certain cow that ordinarily her milk curdled when the 
acidity reached 70°-75°, whereas the milk of the same cow when 
fatigued by work, curdled when the acidity reached 45°. Accord- 
ing to Moerman (78) also, work lessens the amount of milk secreted 
and raises the proportion of solids. The differences, however, in 
the quantity and quality of the milk in all of these investigations 
were only slight, indeed in some instances the results obtained were 
not very definite. 

PART II.— CHANGES IN THE COMPOSITION OE MILK. 

On account of the milk sugar and proteids which milk contains, it 
is an exceedingly unstable liquid. When first drawn from the cow, it 
has a characteristic odor and a sweet taste. Even in the perfectly 
fresh state, it reacts acid to phenolphthalein. The acidity of fresh 
milk is due primarily to carbonic acid and acid phosphates and also 
in part to dicalcium caseinogenate. According to Thorner (1) the 
acidity of fresh milk varies between 12 and 16 degrees. According to 
Richmond (2) it has an acidity of 20 degrees. On standing exposed 
to the air for some time it gradually loses its sweet taste. The sugar 
of milk is gradually transformed into lactic acid through the action 
of bacteria. The milk becomes sour to the taste and ultimately clots 
or curdles as the result of the precipitation of the caseinogen by the 
combined action of acids and soluble calcium salts. Stokes (3) gives 
figures and tests to show that milk having an average acidity of 44 
degrees, corresponding to 0.396 per cent of lactic acid, tastes sour. 
According to Richmond (2) milk tastes sour when the acidity reaches 
45 degrees, corresponding to 0.405 per cent lactic acid, and when it 
has an acidity of 85 degrees, equivalent to 0.765 per cent of lactic 
acid, it curdles at ordinary temperatures. 

Under certain conditions, milk may also develop rancid and cheesy 
odors which render it quite disagreeable. 

The principal changes occurring in milk are those produced by — 

(1) The action of heat and acids. 

(2) The action of milk enzymes. 

(3) The action of the digestive enzymes. 

(4) Bacteria and various other micro-organisms. 

Part II. — (1) Changes in Milk Produced by the Action of Heat and Acids. 

When milk is heated a film or skin forms on the surface, which, 
according to Jamison and Hertz (4) , is due to the drying and coagu- 
lation of a part of the proteids which the milk contains. They 
have shown that such a skin may be formed on the surface of any 



329 

albuminous solution containing fat or paraffin. Rettger (5) also 
has arrived at the conclusion that its formation is dependent on the 
presence of proteid. This proteid is caseinogen. Surface evapora- 
tion and the presence of fat facilitate its formation although neither 
is absolutely essential. According to Harris (6), also, the scum of 
boiling milk consists very largely of caseinogen. It is also well 
known that certain changes occur in the odor and taste of milk as 
the result of boiling. These changes seem to be due to the partial 
decomposition of certain of the proteids with the liberation of a 
volatile sulphide, probably hydrogen sulphide. That such is the case 
has been proven by Rettger (7) , and also by Franz Utz (8) . Accord- 
ing to the former, when milk is heated to 85° C., a volatile substance, 
probably hydrogen sulphide, is liberated. The amount of this, 
though small, suffices to blacken lead acetate paper and to decolorize 
dilute solutions of potassium permanganate. He found that alkalis 
and alkali phosphates accelerate the formation of the sulphide, 
whereas acids and acid phosphates retard this change. According 
to this author this change is believed to indicate proteid decomposi- 
tion, and may partly account for what some observers describe as 
the injurious effect of heating milk. These observations have been 
confirmed by Utz (8), who was able to recognize the hydrogen 
sulphide resulting from the boiling of milk by lead acetate paper 
and also by Ganassini's reagent 

When milk is boiled there seems also to be a partial fixation of the 
calcium salts which it ordinarily contains. These are probably par- 
tially precipitated in the form of tricalcium phosphate. This would 
account for the fact that the coagulation of milk by rennin takes 
place more slowly in boiled milk than in unboiled milk. (See p. 332.) 
In this connection Wassermann and Schtitze (9) have pointed out 
that cooked milk is not coagulated by lactoserum. According to 
P. T. Muller (10) the fact that cooked milk can not be coagulated by 
lactoserum is in some way associated with a diminution in the quan- 
tity of soluble calcium salts contained in the milk, this diminution 
having been caused by the action of heat. On the other hand, both 
Moro and Muller (10) have observed that certain milks do not show 
any diminution in coagulability by lactoserum after boiling. Ac- 
cording to Muller (10) this is to be attributed to the large amount 
of soluble calcium salts present in the milk of certain particular 
localities, and in this connection he has observed that the coagula- 
bility by lactoserum may be restored to boiled milk by the addition 
of soluble calcium salts. 

Hammarsten observed that milk curdles when it is heated to 130° 
to 150° C. (see p. 344). Cazeneuve and Haddon (11) observed that 
milk which had been coagulated at 130° C. became very acid. Ac- 



330 

cording to these observers it then contained formic acid. They also 
reached the conclusion that the discoloration and coagulation of 
milk by heat is due to the oxidation of lactose in the presence of the 
alkaline salts of the milk, one product of the oxidation consisting of 
formic acid, which, like other acids, precipitates the caseinogen. 
The latter undergoes no further change except that it is discolored 
by the products of the decomposition of lactose. 

Bruno Bardach (12) has also studied the coagulation of milk by 
heat. He found that about twelve hours' heating at 100° C. was 
required in order to coagulate perfectly fresh milk, whereas at 150° 
C. it coagulates in three minutes, and at 130° C. in one hour. He 
found only the merest traces of formic acid to be formed at 130° C. 
He concludes from his study of the subject that the coagulation of 
milk by heat is a complex process; that it is brought about by the 
action at the high temperature of the small quantities of acid which 
are formed from the lactose, and which ordinarily are powerless to 
coagulate the original unchanged casein (caseinogen), and that it is 
only after the casein (caseinogen) has been changed by the action of 
heat that such small amounts of acid can cause its coagulation. 

The part played by calcium salts in the acid coagulation of milk 
has been studied by Loevenhart ( 13 ) . According to this author the 
very small quantities of acid required to effect the coagulation of 
milk at temperatures at or below boiling accomplish this change by 
rendering the calcium salts normally present in milk available for 
the coagulation of the caseinogen. Therefore the temperature at 
which a given specimen of slightly sour milk will coagulate on heat- 
ing depends partly upon the degree of acidity and also upon the 
nature and amount of the calcium salts present in the milk. 

Von Soxhlet (14) has also recently investigated the coagulation 
which occurs on boiling faintly acid milk. He observed that at the 
commencement of the souring of milk boiling causes a coagulum 
to form. This occurs when only one-eighth of the amount of acid 
necessary to produce coagulation at ordinary temperatures is present. 
It depends, according to this author, on the formation of an insoluble 
compound of caseinogen with soluble calcium salts, the acid first 
produced forming monocalcium phosphate from the dicalcium phos- 
phate present in the fresh milk. 

The fact that milk occasionally curdles in the pasteurizing appa- 
ratus during pasteurization makes the accumulation of data bearing 
on this particular phase of the subject a matter of considerable im- 
portance. During our recent investigations of the Washington milk 
supply we incidentally made a number of observations on the coagu- 
lation of slightly sour milk at or below boiling. The results of these 
observations, aranged in the order of diminishing acidity, are given 
in the following table : 



331 



No. of 
sample. 


Acidity 

(per cent). 


Temperature 
(°C). 


Time of 

heating 

(minutes). 


Curdled 

= +; not 

curdled = — . 


1 


0.711 


65 


*o 


+ 


2 


.594 


65 


1 


+ 


3 


.576 


65 


2 


+ 


4 


.567 


65 


1 


+ 


5 


.554 


60 


2 


+ 


6 


.531 


65-67 


2 


+ 


7 


.513 


65 


2 


+ 


8 


.478 


60 


5 


+ 


9 


.450 


65 


If 


+ 


10 


.441 


66 


1 


+ 


11 


.387 


65 


5 


+ 


12 


.351 


65-67 


2 


+ 


13 


.351 


65 


5 


+ 


14 


.351 


65 


5 


+ 


15 


.342 


78.5 


2 


+ 


16 


.342 


66 


5 


- 


17 


.315 


70 


10 


+ 


18 


.315 


70 


5 


- 


19 


.315 


65 


5 


- 


20 


.306 


75 


3 


+ 


21 


.306 


65 


5 


- 


22 


.288 


70 


5 


*— 


23 


.261 


65-74 


5 


- 


24 


.252 


100 


1 


- 


25 


.252 


70 


5 


- 


26 


.243 


100 


1 


- 


27 


.243 


72-74 


10 


- 


28 


.243 


65 


10 


- 


29 


.234 


65 


5 


- 


30 


.225 


65-67 


2 


+ 


31 


.198 


65 


5 


- 


32 


.180 


65 


5 


- 



* Immediately. 

It will be seen from our results that of those samples of milk 
which coagulated on heating, sample 30 contained the smallest 
amount of acid at the time of coagulation, viz, 0.225 per cent. This 
sample curdled in two minutes at 65°-67° C. It will be observed 
that milks containing from 0.306 to 0.315 per cent of acid curdled 
at temperatures varying from 65°-78.5° C., in from two to ten min- 
utes, and that as a general rule those milks are most easily coagulated 
by heat which have the highest acidity. On the other hand, while 
one of the samples having an acidity of only 0.225 per cent curdled 
at 65°-67° C, in two minutes, another sample containing 0.243 per 
cent of acid did not curdle even on boiling. Thorner (15) found 
the acidity necessary to coagulate milk on heating to be 0.207 per cent. 
On the other hand, Rideal (16) found the amount of acid required 
to effect the coagulation to be somewhat higher than this. According 
to him the tendency to coagulate is not very marked even when the 



332 

acidity is as high as 0.23 per cent. Rideal's observations agree very 
nearly with our own. 

According to Stokes (3) milk which has an acidity somewhat less 
than 0.3 per cent of lactic acid will coagulate on boiling. He records 
the fact, however, that 3 samples of milk containing as much as 
0.54 per cent of lactic acid did not coagulate on boiling. 

Richmond (2) has been able to confirm Stokes's results almost 
absolutely. He found fresh milk to have an acidity of 20 degrees, 
corresponding to 0.18 per cent lactic acid. According to him milk 
curdles on boiling when it has an acidity of 33 degrees, corresponding 
to 0.297 per cent of lactic acid. 

Re vis and Payne (17) have shown that at the moment when the 
caseinogen is precipitated the calcium triphosphate has been elim- 
inated, and that the combination of caseinogen with lactic acid has 
reached a maximum. 

It is evident therefore from our results and those obtained by 
other observers that the coagulation of milk is dependent on several 
factors, among which are: time, temperature, degree of acidity, 
quantity and nature of the calcium salts, etc.; and that in order 
to avoid accidents resulting from curdling in the pasteurization of 
milk the only safe rule to follow is to determine the effect of heat 
on small samples of the milk which it is proposed to pasteurize, or 
better still, to pasteurize the milk as soon as it is drawn from the cow. 

Another important change in milk effected by heat is the destruc- 
tion of the bacteria and other micro-organisms normally present in 
fresh milk, including of course those pathogenic forms which fre- 
quently gain access to milk and cause the spread of infections through 
this medium or which give rise directly to highly poisonous sub- 
stances. For obvious reasons therefore this phase of the subject, 
namely, the pasteurization of milk, has received a great deal of 
attention during recent years at the hands of dairymen and sanita- 
rians. It is foreign to the immediate scope of this communication, 
however, to enter upon a discussion of this subject. Suffice it to 
say in this connection that pasteurization either checks or hinders 
those changes which occur in milk as the result of the life and growth 
therein of micro-organisms, and affords more or less adequate pro- 
tection against the spread of microbic diseases through the medium 
of milk. According to Pasteur (18) milk can be sterilized by heating 
it to about 110° C. and Duclaux kept milk five years by heating it to 
120° C. and preserving it in vessels which had been exhausted of air. 

Effect of Heat on Milk Enzymes. 

Another less obvious change in milk which is brought about by 
the action of heat is the destruction of the enzymes normally present 
in fresh milk. Like all enzymes those contained in fresh milk are 



333 

destroyed by boiling or by heating the milk above certain tempera- 
tures. On account of the important bearing which the thermal death 
point of milk ferments may have on the pasteurization of milk the 
following data relative to this subject are here submitted: 

Galactase. — According to Babcock and Russell (19), the destruc- 
tion temperature of galactase, the proteolytic enzyme of milk, is 
somewhat higher than the thermal death point of trypsin. So far 
as its proteolytic activity is concerned, these observers found it 
to be weakened by heating for ten minutes at 76°-80° C. That 
such is the case may be seen from the following table, in which is 
shown the percentage of soluble nitrogen present at the end of fifty- 
three days in milks which had been heated for ten minutes at the 
temperature indicated. 

TABLE i. 



Temperature to 
which the ga- 
lactase was 
heated for 10 
minutes before 
being allowed 
to act on the 
milk. 


Per cent of 
soluble nitro- 
gen after 
53 days at 
37° C.« 


78—80° C. 
76 
71 
65 
60 


0.05 
.05 
.12 
.20 
.20 



a The soluble nitrogen originally present in the milk used in these experiments was found 
to be 0.05 per cent. 

Similar tests were made upon the proteolytic activity of galactase 
towards gelatin, using Fermi's (20) method. Equal amounts of the 
galactase solution were poured over the surface of carbolized gelatin 
contained in test tubes and kept under observation seven weeks. 
The results of this series of experiments is given in Table II. 



L + 



TABLE II. 

=rapid digestion ; + =digestion by galactase ; 



no digestion.] 





Temperature (°C). 


Reaction of the galactase solu- 
tion. 




Alkaline. 


Neutral. 


Acid. 




N/10. 


N/20. 


N/10. 


65 . 


+ 


+ + 


+ + 




70 




75 




80 




Control 


+ 







334 



Hence so far as its power to digest gelatin is concerned the activity 
of galactase is destroyed in alkaline solution by ten minutes' expo- 
sure to temperatures of 65° C. in neutral solutions at 70° C. and in 
acid solutions at a temperature of 65° C. 

Babcock and Russell (19) have also employed the power on the 
part of galactase to accelerate oxidations by hydrogen peroxide as a 
test for the presence of the ferment, and have made use of this test 
as a means of determining the destruction temperature of galactase. 
This we now know is merely a test and measure of the peroxidase 
activity of the solution and not a test or measure of the activity 
of galactase at all. Indeed, as has been shown subsequently to the 
work of Babcock and Russell on this subject, galactase as prepared 
from separator slime is not a pure enzyme, but a mixture of enzymes. 
Thus Wender (21) points out that the galactase of Babcock and 
Russell consists of milk trypsin or galactase proper, milk catalase, 
and milk peroxidase. According to Wender, the trypsin of milk 
becomes inactive at 76° C. 

The use of V. Storch's tests (see p. 333), viz, with an iodide and 
starch or p-phenylene-diamine and a few drops of hydrogen peroxide 
as a means of determining the effect of high temperature on the 
activity of galactase, as employed by Babcock and Russell, is there- 
fore chiefly interesting as throwing light on the stability of milk 
peroxidase under the conditions employed in their work. Their 
results are given in Table III. 

TABLE III. 
[ + =color reaction; X=doubtful reaction; — =no color reaction.] 







Alkaline. 






Temperature (°C). 


Time. 




Neutral 
to litmus. 


Acid 


N/10. 


N/25. 


N/10. 




( 10 


+ 


+ 


+ 


+ 


65 


I 30 


+ 


+ 


+ 


+ 




1 60 


+ 


+ 


+ 


X 




| 10 


+ 


+ 


+ 


+ 


70 


30 


+ 


+ 


+ 


X 




| 60 


+ 


+ 


+ 


' - 




1 10 


+ 


+ 


+ 


X 


75 


I 30 


+ 


+ 


+ 






I 60 


+ 


+ 


+ 


- 




f 10 


+ 


+ 


+ 


- 


80 


J 30 


+ 


+ 


X 


_ 




{ 60 


X 






- 



Babcock and Russell (19) conclude therefore from their experi- 
ments that galactase is more stable in alkaline or neutral solution, and 
that it shows a close resemblance to trypsin, but is les$ sensitive to 
acids than the latter ferment The heat boundary of its activity is 



335 

influenced by the chemical reaction of the solution in which it is 
present, being lower in acid than in neutral or alkaline solution. 
When galactase that has been heated to 70° C. for ten minutes is 
added to milk, the digestion is slowed, and heating to 76° C. for ten 
minutes entirely destroys its digestive powers. In the Fermi (19) 
gelatin tests no digestion took place with specimens of the ferment 
that had been heated to 65° C., whereas with the unheated controls, 
the gelatin liquefied. 

Von Freudenreich (22) has confirmed the observations of Babcock 
and Russell on galactase. According to this observer a temperature 
of 75° C. for half an hour causes a falling off in the proteolytic 
activity of this enzyme. On the other hand, he found an exposure 
to 60° C. for half an hour to scarcely weaken it to a noticeable degree. 
According to Hippius (23) the proteolytic ferments of milk can 
withstand an exposure to 60° C. for one hour and an exposure to 
65° C. for half an hour. 

Milk amylase, according to this author, can withstand a tempera- 
ture of 60° for one hour, but is destroyed by heating above 75° C. 

Milk lipase. — Gillet (24) has found that milk lipase is destroyed 
at 65° C. According to Hippius (23) the lipase of woman's milk can 
withstand a temperature of 60° for one hour and a short exposure to 
62°, but is weakened at 63° C, and is destroyed at 64° C. 

The salol-splitting ferment (Nobecourt and Merklen) is, according 
to Hippius (23), destroyed above 65° C. However, the existence of 
this ferment is doubtful. (See p. 344.) 

Hougardy (25) has found that the activity of lactokinase is greatly 
enfeebled by heating for twenty minutes at 75° C. and practically 
destroyed by heating for half an hour at this temperature. 

The oxidizing ferments of milk. — While our knowledge of the solu- 
ble ferments is of too recent date for an exact understanding of their 
significance and powers of resistance, the well-known reactions of 
the oxidases have furnished us with a useful criterion for distin- 
guishing between raw (living) and heated milk (Zelinski 26). 

According to Marfan (see Zelinski (26)) the oxidases of milk are 
destroyed at 79° C. According to Hippius (23) they can withstand 
a temperature of 60° C. to 65° C, but are destroyed by a short 
exposure to 76° C. 

Peroxidases. — According to Wender (21) the peroxidase of milk 
becomes inactive at 83° C. According to Schardinger (27), using 
methylene blue as a reagent, the critical temperature of the milk 
peroxidases is 80° C. With Arnold's guaiacum reagent milks heated 
to 80°, according to Ostertag, failed to show the reaction (see Glage 
(28)). Franz Utz (29), using Schaffer's (30) reagent, found that 
milk heated for a short time at 90° C. or a long time at 70° C. failed 



336 

to show any reaction. Eullmann (31) gives the following data bear- 
ing on the stability of the peroxidases of milk, as shown by Storch's 
p-phenylene-diamine reagent : 



Raw milk, not heated. ] 

Milk heated one hour, 68°-69° C. } Deep S reenish blue at once - 



1. Raw milk, not heated 
2, 

3. Milk heated one-half hour, 72° C. 

4. Milk heated one-half hour, 90° C. I No coloration after ten minutes. 

5. Milk boiled one-half hour. 

V. Storch (32), employing his own reagent, found that exposure of 
the milk to a temperature of 75° C. for two minutes prevented the 
reaction. Freeman (33), working with Storch's reagent, found a 
temperature of 78° C. to destroy the peroxidase of milk. Du Eoi and 
Kohler (34) have employed hydrogen peroxide and the potassium- 
iodide-starch reagent and have found 80° C. to be the limit of the 
reaction. Weber (35) recommends Arnold's (36) reagent (guaiacum 
in acetone), and finds the temperature limit of the reaction to be 
about 80° C. Franz Utz (37), using a solution of ursol D, finds that 
milks which have been heated to 80° or above fail to give the peroxi- 
dase reaction. According to Eullmann (38) practically all bacteria 
are destroyed in cow's milk by heating it for one hour to 68°-69° C. ; 
whereas, using p-phenylene-diamine Irydrochloride, which he found 
to be the most delicate reagent for the peroxidase, he found that the 
latter was not destroyed unless the temperature exceeded 70° C. 
According to Van Itallie (39) the peroxidases of milk are not de- 
stroyed below 80° C, and milk sold as pasteurized milk gave the test 
with paraphenylene diamine and hydrogen peroxides Bruere (40) 
observed that milk which had been pasteurized at 80° C, or boiled, 
failed to show the peroxidase reaction with the gnaiacol reagent. 
Dupouy (41), using freshly prepared paraphenylene-diamine and 
hydrogen peroxide, found that unheated milks gave a blue color, 
whereas those heated above 79° C. gave no color with this reagent. 

Douglas (42), using ortol as a reagent, found that heating for five 
minutes at 75° C, or one minute at 80° C, destroys the peroxidase 
of milk. Marfan and Gillet (43), using guaiacol as a reagent for the 
peroxidases in milk, found the ferments still active at 70° C. They 
were weakened at 75° C, however, and were destroyed at 78° C. to 
79° C. Macadie (44) found that nearly all photographic developers, 
together with small amounts of hydrogen peroxide, give characteristic 
color reactions with milk which has not been heated above 75° C. 
Wilkinson and Peters (45), using benzidine and hydrogen peroxide, 
failed to obtain the peroxidase reaction with milks which had been 
heated to 78° C. or higher. 

° We have also found pasteurized milk to show the peroxidase reaction, with 
guaiacum, p-phenylene-diamine and also with phenolphthalin. 



337 

Using an acetone solution of guaiacum (purified according to 
Portier (46) and dilute hydrogen peroxide) we made the following 
observations on the resistance of the milk peroxidases to heat : 



Temperature 
(°C). 


Time of 


exposure. 


Color with reagent. 


70 


5 minutes 


Dark blue. 


70 




Do. 


72 




Do. 


70 




Dark blue; slow in developing. 


70 


60 minutes 


60 






60 


30 minutes 


Do. 


60 




Dark blue; somewhat slow in developing. 







It is evident, therefore, that while short exposures of milk to a 
temperature of 60° C. are apparently without effect on the activity 
of the peroxidases, an hour's exposure to this temperature renders 
them somewhat less active than in unheated milk, and an exposure 
of one hour to a temperature of 70° C. destroys them. 

It was also observed that milk just brought to 75° C. and 80° C. no 
longer gives the blue color with the guaiacum reagent. An examina- 
tion of curdled milk with this reagent revealed the presence of the 
peroxidase chiefly in the whey and apparently in unaltered condition 
so far as activity is concerned. 

[Since the foregoing was written the whole subject of the peroxi- 
dase reaction of milk has been thoroughly investigated by Kastle 
and Porch (47). These observers succeeded in showing, first, that 
the power of milk to induce the oxidation of phenolphthalin and 
other leuco-compounds by hydrogen peroxide is greatly intensified 
by certain substances of the phenol type ; and that by the use of these 
peroxidase-accelerators, phenolphthalin, guaiacum, and parapheny- 
lene- diamine can all be used to advantage and with certainty as per- 
oxidase reagents for milk; second, that the fresh milks of different 
cows of the same herd exhibit considerable differences in peroxidase 
activity ; third, that by means of the peroxidase reaction thus modi- 
fied it is possible to distinguish between raw and cooked milk or 
between raw milk and that which has been sterilized at a temperature 
of 70° C. or higher for short intervals, and that while milks which 
have been heated to 70° C. for one hour, or to 75° C. for twenty 
minutes, no longer show the peroxidase reaction, this reaction is not 
diminished in intensity, but, if anything, somewhat increased, by 
heating the milk to 60° C. for twenty minutes. It is evident, there- 
fore, that the pasteurization of milk at 60° C. for twenty minutes, 
as recommended by Rosenau, does not destroy the biological proper- 
ties of milk, at least so far as we are able to judge from the per- 
oxidase reaction.] 

45276°— Bull. 56—12 22 



338 

Catalase. — Less is known concerning milk catalase than is known 
of the peroxidases. It would seem, however, that it is perhaps more 
sensitive to heat than the peroxidases. Van Itallie (48) has shown 
that cow's milk is unable to decompose hydrogen peroxide after an 
exposure of one-half hour to 63° C. On the other hand, human milk 
still retains this power after a similar exposure. According to Jolles 
(49), heating to 75° C. destroys the catalases of woman's milk com- 
pletely. Wender (21) observed that catalase prepared from separa- 
tor slime (see galactase) becomes inactive at 80° C. 

Other biological properties. — According to Hippius (23) the bac- 
tericidal power of milk is retained even after long heating at 60°-65° 
C., but is weakened by a short exposure to 85° C, whereas according 
to Behring (50) this property of milk is lost after an hour's heating 
to 60° C 

The alexins of milk, according to Behring, are affected by heat in 
exactly the same way and to the same extent as the antibacterial sub- 
stances. Lane-Claypon (51) has shown that on adding blood 
corpuscles to milk the cream picks them up and carries them to the 
top, and that this property of milk is destroyed by heating it to 70° 
C. for a few minutes. It is evident, therefore, from these considera- 
tions, that the thermal death point of the milk ferments is dependent 
on a number of conditions besides the temperature itself. Chief 
among these are time and the reaction of the medium. As a rule, 
the soluble ferments can withstand somewhat higher temperatures in 
neutral or slightly alkaline solution than in acid solution. Acidity 
and temperature naturally augment the destructive powers of each 
other toward the enzymes. This accounts for the apparent dis- 
crepancies existing among such observations. In general, it may be 
said, however, that the milk ferments, most of them at least, can 
withstand a temperature ranging from 60°-65° C. for some time, 
without material injury. Between 65° C. and 70° C. most of them 
are weakened in their activities, and between 70° C. and 80° C. all 
of them are destroyed, even after relatively short exposures. 

According to Raudnitz (52) all the ferments of milk are destroyed 
between 75° C. and 90° C. (See also Tjaden, Koske, and Hertel (53), 
and also E. Weber (54), for further information bearing on this 
point.) 

The digestibility of raw and heated milk. — In this connection the 
effect of heat on the digestibility of milk proteids has been the sub- 
ject of considerable investigation. According to Kerr (55) milk is to 
be looked upon as consisting of living cells suspended in serum, the 
former consisting of fat cells and nucleated cells of the nature of 
white blood corpuscles. (As a matter of fact it has been definitely 
proven that leucocytes do actually occur in milk — see p. 491.) Ac- 
cording to Kerr, when milk is ingested, these living elements are at 



339 

once absorbed without any preliminary digestion, and are utilized 
directly in the building up of the tissues. The effect of boiling there- 
fore is obviously to kill all of the living cells of the milk, and to coagu- 
late certain of the albuminoid constituents. The result of the boiling 
therefore is that all of the constituents of the milk must be digested 
before they can be absorbed into the system. Hence there is a dis- 
tinct loss of utility in the milk as the result of boiling. He goes on 
to say further that it has been observed by many medical practi- 
tioners that there is a very distinctly lowered vitality among infants 
which are fed on boiled milk, the process of absorption being delayed 
and the quantity of milk required for the nourishment of the child 
being greater than when fresh milk is used. 

While this is doubtless an extreme view to take of the matter, there 
are quite a number of observers who believe that the proteids of milk 
are considerably altered by boiling. Thus according to Hallibur- 
ton (56) the milk proteids are rendered somewhat more difficult of 
digestion as the result of heating. Eubner (57) has observed that 
even a short heating at 100° C. coagulates the lactalbumin, an obser- 
vation which has been confirmed by Middleton (58). De Jager (59) 
has also arrived at the conclusion that the digestibility of milk dimin- 
ishes with cooking, and also that caseinogen is more readily digestible 
than casein and that infants stand raw milk better than cooked. 

In this connection it has been observed by Lorcher (60) that 
cooked milk coagulates with rennin more slowly than uncooked milk. 
This effect is noted even at temperatures of 80°-90° C. This is 
shown by the following : 

Ten cubic centimeters of milk was heated to the following tem- 
peratures for five minutes, then cooled to 35° C., and 0.5 cubic centi- 
meter of rennin solution added, and the time required for coagulation 
noted. The following results were obtained : 





Temperature (°C). 


; Time re- 
I quired for 
' coagulation 
1 (minutes). 




Temperature (°C). 


Time re- 
quired for 
coagulation 
(minutes). 


50... 
60... 
70... 




4| 

u 

4 S 


80.... 
90.... 
100.. 




H 
81 

9^ 



The probable explanation of the retardation of the rennin coagula- 
tion resulting from the heating of milk is that the calcium salts are 
partly rendered insoluble, probably through conversion into trical- 
cium phosphate, so that even the mineral constituents of milk seem 
to be somewhat altered by boiling. 

On the other hand there are those, among them Forbes-Ross (61), 
who contend that heat exerts no deleterious effect on the digestibility 
of milk, and that the feeding of infants with boiled milk is not in 



340 



any way responsible for scurvy or rickets, but in reality is a wise 
precaution against infantile diarrhea and other bacterial diseases. 
Similarly Tjaden, Koske, and Hertel (53) claim that by rapidly 
heating the milk to 90° C, with constant shaking, the chemical and 
physical properties of the milk are in no wise altered nor is the value 
of the milk as a food in any way impaired. 

These fundamental differences of opinion regarding the effect of 
heat on the digestibility of milk can therefore only be settled by 
further investigations along this line. 

By way of comparison there are given in the subjoined table cer- 
tain data pertaining to the destruction by heat of enzymes in general. 

This table has been compiled from observations recorded by Green 
(62), Oppenheimer (63), and others. 



Name of ferment. 


Temperature at which 
destroyed (°C). 


Name of ferment. 


Temperature at which 
destroyed (°C). 




Weakened at 70. 
80, weakened at 70. 
60. 
75. 
80. 

65-70, slowly at 58. 
70. 

65 (slowly). 

70, very slowly at 45-50. 
60-63. 

72(Hanriot), 65-70 
( Kastle & Loe venhart ) . 


Maltase 


55. 




Myrosin 


81-85. 






72. 






82.5. 






55-57. 


Diastase (saliva) 


Rennin 


70, neutral; 63, faintly 






64. 




Trypsin 


75-80. 






70 (Schmidt). 
55. 


» 








75-80. 









P. T. Miiller (64) gives the following data bearing on the subject of 
the resistance of the several ferments to heat: Hemodiastase (Hahn) 
is not destroyed at 55° C. It is weakened by heating to 66° C. for 
half an hour and at 65°-70° C. is destroyed. Parachymosin (Bang) 
withstands a temperature of 75° C. for some time. Papain is weak- 
ened -at 75° C. and destroyed at 82.5° C. The oxidizing ferments 
(Abelous and Biarnes) increase in activity from 0° C. to 60° C. At 
80° C. they are still active and are first destroyed at 100° C. Lacto- 
serum (P. T. Miiller) is rendered inactive by heating for half an 
hour, at 70°-75° C. So far then as the influence of temperature on 
their activity is concerned it is evident that the milk enzymes are 
much like enzymes from other sources. Indeed they are all very 
much alike and all of this great group of substances stand in such 
intimate and close relation to the vital activities of the cell that all 
of those conditions and influences which tend to destroy the one tend 
also to destroy the other. (See also Kastle (65) " On the Vital 
Activity of the Enzymes.") All of the bacteria of milk can not be 
destroyed therefore without at least diminishing the activity of the 
milk enzymes or perhaps destroying them altogether and the enzymes 
can not be destroyed without rendering the milk sterile. 



341 

Similar conclusions have been reached by Marfan (66). According 
to this author the enzymes in general can not withstand a tempera- 
ture higher than 70° C., so that by heating milk to deprive it of its 
bacteria, we also deprive it of those ferments which probably exer- 
cise a favorable influence on nutrition. He is of the opinion, how- 
ever, that this is not sufficient ground for doing away with the prac- 
tice of sterilizing milk by heat. In this connection Rosenau has 
recently made the important observation that the pathogenic 
bacteria commonly found in milk are either killed or rendered inert 
by exposure to 60° C. for twenty minutes, see Hyg. Lab. Bull. No. 42. 

Bokorny (67) has also pointed out that between protoplasm and 
the enzymes there are certain striking similarities. Toward temper- 
ature, he says, it has long been known that the enzymes conduct 
themselves like protoplasm. His table, setting forth these analo- 
gies so far as the influence of temperature and light are concerned, 
is given in the following : 



Name of protoplasm or enzyme. 



Action of temperature, light, etc. 



Protoplasm of bacteria and fungi . 



Lower plants and animals. 



Zymase (yeast) 

Maltase or glucase 

Invertase (from yeast) 

Diastase (of malt) 

Emulsin 

Myrosin 

Pepsin (from the stomach) 

Trypsin (from pancreas) . . 

Papain (vegetable trypsin) 

Rennin 

Catalase (Loew) 

Laccase (Bertrand) 



Nageli found the spores of bacillus subtilis could be heated 11 
hours in boiling water without showing the slightest damage. 
In the vegetative state this organism is largely destroyed by 
heating to 55°-60° C. 

Light tends to destroy many bacteria. 

Direct sunlight destroys by long exposure. 

A temperature of 25°-30° C best for the development of yeast. 

Young vegetative yeast-cells are killed at 50°-60°C, spores at 
60°-65° C. In the dry state yeast withstands 125° C. 

Spirogyra killed in water at 45°-50°.a Many algae live in the 
Carlsbad thermal springs, temperature- 53° C. Some forms of 
algse have been found in thermal springs having a temperature 
of 85° C 

Salt-water amcebas are killed at 35° O; fresh- water amcebas at 
40°-45° C 

Strong light is harmful. 

Optimum temperature, 25° C; loses activity at 0° C and is de- 
stroyed at 53° C 

Yeast maltase destroyed at 55° C. Maize maltase acts best at 35° C 

Quickly destroyed when moist at 70°C, and at 50°C. when heated a 
a long time. Optimum temperature, 31° C; according to Kjel- 
dahl, 52°-56° C 

Moist heat kills at 75° C, after short exposure. Dry diastase stands 
100° C. and over. Optimum temperature, 50°-55° C. 

Sunlight kills it. 

Optimum temperature, 45°-50° C; destroyed at 70° C. In dry 
state stands 100° C. for hours. 

Inactive at 0° C; thermal death-point, 85° C 

In 0.2 per cent hydrochloric acid, optimum temperature, 35°-40° 
C Death-temperature, 56°-60° C. Dry, stands 160° O for a 
short time. 

Optimum temperature, 40° O; death-temperature, 69°-70° C. In 
dry state can be heated to 160° C without harm. 



Killed at 75° C. Dry, stands 100° C 
Higher than 70° C. kills quickly. 



Optimum temperature, 40° C. 

Optimum temperature, 40° C. 

Death-temperature, 72°-75° C. 

Optimum temperature, 20° C. Destroyed at 60°-63° C. ( Yoshida). 
Destroyed at 70° .C. (Bertrand). 



° The water-plant Hottonia shows a maximum assimilation of carbon dioxide at 31° C. 
This is only one-fourth as strong at 50° C, and at 56° C. it ceases altogether. 



342 

Part II. — (2) Changes in the Composition of Milk Produced by the Milk 

Enzymes. 

According to Marfan (1), milk is not an inactive fluid, but pos- 
sesses properties which are more or less characteristic of living tissues. 
For example, it gives Bordet's reaction, namely, that when the milk of 
one species of animal is repeatedly injected into the blood of an 
animal of different species the blood serum of the animal so treated 
gradually acquires the power of coagulating milk in much the same 
way as rennin. (See P. T. Miiller (2) " Vergleichende Studien Ueber 
die Gerinnung des Kaseins Durch Lab und Lactoserum.") Human 
milk is said by Moro (3) to have the power of coagulating hydrocele 
fluid, whereas cow's milk does not give this reaction. 

As already indicated on page 313, milk contains a number of soluble 
ferments, such as diastase (amylase), galactase, lipase, lactokinase, 
peroxidase, reductase, and catalase. 

In the present state of our knowledge we know very little of the 
actual functions of the milk ferments. According to Marfan (1), it 
is probable that the milk ferments act as stimulants and regulators 
of nutrition and that they are identical in function with the enzymes 
elaborated by the various tissues and are intended to compensate 
for the deficiency of the internal secretions of the new-born. Accord- 
ing to this author the presence of specific ferments in the milk of 
a particular animal species probably explains the value of natural 
over artificial milk feeding. 

Engel (4), in discussing Moro's work on the influence of the milk 
ferments on nutrition, arrives at the conclusion that while these 
ferments are apparently characteristic for the milk of any partic- 
ular animal species, we can not yet come to any definite conclu- 
sions respecting their influence on animal nutrition. He calls atten- 
tion to the fact that Moro's curves showing the increase in weight of 
two sucklings both fed by the bottle, one on fresh and the other on 
boiled human milk, showed but little differences. Both curves 
showed that both children thrived less well during the second period. 
Concerning the function of the milk ferments see also Moro (5). 

On the other hand certain of these ferments bring about changes 
in the composition of milk which require some consideration in this 
connection. The following are the principal facts of interest con- 
cerning the soluble ferments found in milk and the changes which 
they effect in the composition thereof, except for what has been given 
already on this subject. 

Diastase {amylase) of milk. — In 1883 Bechamp (6) isolated from 
human milk an enzyme which liquefies starch and converts it into 
sugar as readily as diastase. According to this author this ferment 
was obtained from successive portions of milk as soon as drawn from 



343 

the teat, and hence is a product of the milk gland itself, and not 
formed by the action of milk stagnated in the gland. Attempts 
to isolate this ferment from cow's milk by Moro (5) and by Van 
der Yelde and Landtsheer (7) have not proven successful. That a 
diastatic ferment does not occur in cow's milk has also been con- 
firmed by Kastle. At present nothing definite is known regarding 
the function of this enzyme in human milk, and so far as we know 
it is not responsible for any alteration in the composition of any con- 
stituent of the milk itself. 

Galactase. — This proteolytic ferment was first recognized by Bab- 
cock and Kussell (8) in 1897, and has been found by these observers 
in the milk of the cow, woman, sheep, goat, pig, horse, and half- 
breed buffalo. By the methods ordinarity employed in the prepara- 
tion of enzymes, these authors succeeded in preparing from the fresh 
centrifuge slime of milk that had been kept continuously in contact 
with chemical antiseptics aqueous extracts possessing proteolytic 
properties to a marked degree. These extracts were also observed 
to have the power of curdling fresh milk, similarly to rennin, and 
also of rapidly decomposing hydrogen peroxide. Galactase has been 
found to be similar to trypsin in its action on proteids, converting 
them into proteoses and peptones and finally into amino-acids. Like 
trypsin it has been found to be most active in solutions that are 
slightly alkaline to litmus, and like all ferments it is easily destroyed 
by heat. 

Some idea of the changes produced in milk by the action of this 
enzyme may be formed from the results of analyses made by Bab- 
cock and Russell of milks that were allowed to stand for various 
intervals of time in the presence of an antiseptic to prevent the 
growth of bacteria. These results are given in the following table: 



Description of milk. 



Per cent of 

proteids in 

soluble 

form. 



Average of fresh whole milks analyzed 

Average of whole milks, 20-25 days old 

Average of centrifugal skim milks (fresh) 

Average of centrifugal skim milks, 8-12 months old. 
Maximum found in skim milk 



21.07 
38.27 
25.26 
73.30 
91.18 



The proof of the enzymic nature of these changes is shown by the 
stability of milk heated to a sufficiently high temperature to destroy 
such ferments, and by the fact that fresh milks when preserved with 
powerful antiseptics, such as mercuric chloride, formalin, etc., un- 
dergo no change even though they be kept for indefinite periods of 
time. 



344 

These observations on galactase have been fully confirmed by Von 
Freudenreich (9) and other investigators (10). Wender (11) has 
shown, however, that galactase as ordinarily prepared from separator 
slime, according to Babcock and Kussell's method, in reality consists 
of at least three distinct enzymes, viz, gallactase proper, peroxidase, 
and catalase. Ordinarily galactase by itself acts too slowly to cause 
any material change in the proteids of milk in the short intervals 
which usually elapse between the withdrawal of the milk from the 
animal and its consumption as food. It is claimed by Babcock and 
Russell, however, that this enzyme probably assists in those changes 
which ordinarily take place in the ripening of cheese. It is also 
claimed by Snyder (12) that when milk is used in a mixed diet the 
proteids have been found to be from 4 to 5 per cent more digestible 
than when milk is omitted from the diet. This increased digestibility 
he claims is due to the milk enzymes. In this connection, it is of 
interest to note that Hougardy (13) has recently shown that cow's 
milk contains a ferment or a kinase similar to enterokinase. The 
author proposes to call this ferment lactokinase. This lactokinase 
has been found to accelerate the digestion of proteids by pancreatic 
juice and loses its power to facilitate this change at 73° to 75° C. 

Lipase. — Marfan and Gillet (14) found a lipase in milk capable of 
hydrolyzing monobutyrin. Human milk exhibits this property to a 
higher degree than cow's milk. The former was found to have a 
lipolytic activity of 20-30 on Hanriot's scale, while cow's milk shows 
an activity of only 6-8. Gillet (15) has shown that the milk of differ- 
ent animals contains the lipolytic ferment. This ferment withstands 
cold, but is destroyed by heating to 65° C. It is nondialyzable and is 
held back by the porcelain filter. It probably hydrolyzes the higher 
fats of milk at least to some extent and may possibly account for a 
small part of the acidity of sour milk. 

In this connection Rogers (16) has observed that this ferment is 
present in butter and on standing increases its acidity. 

The so-called " salol- splitting ferment." — Nobecourt and Merk- 
len (17) observed that human and ass's milks have the power of hy- 
drolyzing salol (phenyl salicylate). For a time this hydrolysis was 
believed to be accomplished by an enzyme, to which the name of " the 
salol-splitting enzyme " was given. It was afterwards shown, how- 
ever, by Desmoulieres (18) and also by Miele and Willem (19) that 
no such ferment exists in milk and that this decomposition of salol is 
in reality a saponification brought about by the alkali present in cer- 
tain milks, and that only those milks having an alkaline reaction are 
capable of effecting this decomposition, so that this probably disposes 
of this subject. 

The oxidizing ferments of milk. — Milk contains no true oxidases or 
oxidizing ferments proper. It does decompose hydrogen peroxide, 



345 

however, and in the presence of small amounts of hydrogen peroxide 
or ozonized oil of turpentine it has the power of effecting the oxida- 
tion of a considerable number of easily oxidizable substances. In 
other words, milk contains catalase and peroxidase. These have 
been referred to in the literature by these names ; and also more or less 
indiscriminately by certain writers as the oxidizing ferments of milk 
or superoxidases, and also by some as the indirect oxidases. 

Catalase. — From what is known of the wide distribution of the 
catalases among living things and plant and animal secretions it 
seems probable, although it can not be said to be known absolutely 
at present, that the fresh milk of all animals has the power of decom- 
posing hydrogen peroxide more or less easily. Jolles (20) has 
pointed out that human milk decomposes five or six times as much 
hydrogen peroxide in the same length of time and under the same 
conditions as cow's milk. This author is inclined to attach consid- 
erable importance to this reaction, and recently Von der Velden (21) 
also lays emphasis on the fact that the presence of catalase in human 
milk serves to distinguish it from cow's milk. On the other hand, 
the fact that cow's milk can decompose hydrogen peroxide is attested 
by many observers, some of whom, among them Amberg (22), have 
called attention to the gradual disappearance of hydrogen peroxide 
in cow's milk on standing, and others, van Itallie (23) among them, 
to the fact that cow's milk loses its power to decompose hydrogen 
peroxide on heating to 63° C. Faitelowitz (24) has shown that the 
catalase of milk is associated with the fat globules. This has been 
confirmed by Reiss (25), who further points out that the catalase of 
milk is insoluble in the presence of colloids. 

In the present state of our knowledge we know very little concern- 
ing the function of catalase in living tissue and active secretions. The 
view has been advanced by Loew (26), who has made extensive 
studies in this field, that the function of catalase is to destroy any 
hydrogen peroxide that may have been formed during the respiratory 
processes in the living cell, thereby preventing the accumulation of 
this and other peroxides, all of which are more or less toxic in their 
effects, thus affording protection against a toxic product of respira- 
tion. The question whether hydrogen peroxide is formed in the res- 
piratory process in plants or animals is a much-mooted question, and 
there has been considerable difference of opinion among chemists as 
to whether hydrogen peroxide ever occurs in animal or vegetable tis- 
sues. One thing is certain, however, and that is, whether hydrogen 
peroxide occurs therein or not other complex peroxides do occur, espe- 
cially in plant tissues and exudations (see Bach's (27) investiga- 
tions), and quite recently in an investigation of remarkable interest 
and far-reaching importance, Usher and Priestley (28) have confirmed 
Erlenmeyer's (29) theory of the origin of carbohydrates in green 



346 

plants, which supposes these substances to originate from formic 
aldehyde, which in turn results from the reaction of carbon dioxide 
with water, as indicated in the following equations : 



(1) 0O,+2H,O=™»™+HA 



formic acid 

and 

(2) H 2 C0 2 +H 2 0= formi ^gg h y de +H 8 2 . 

In this reaction hydrogen peroxide is formed, and of course if 
allowed to accumulate in the cell would soon put a stop to all of its 
vital activities. According to Loew, however, the accumulation of 
hydrogen peroxide would be prevented by its decomposition, prac- 
tically as fast as formed, by the catalase. 

Quite recently Usher and Priestley (30) have succeeded in demon- 
strating the decomposition of carbon dioxide by means of chlorophyll 
within and outside of the plant and in proving the presence of formic 
acid, formic aldehyde, and hydrogen peroxide among the products 
of the decomposition. As already stated this work is of unusual 
interest, and if confirmed by subsequent investigations will go a long 
way toward bringing about an .understanding of this important 
biochemical process and will enable us to understand better the 
function of the catalases in general. Of course if hydrogen peroxide 
or similar peroxides are present in milk they must of necessity have 
a different origin from the peroxides occurring in the cells of chloro- 
plryllous plants. It is readily conceivable, however, that such 
peroxides might originate in animal tissues and secretions in other 
ways, and if, in the one case, it is established that the function of 
catalase is to destroy hydrogen peroxide and thereby prevent its 
accumulation in the cell, it will probably turn out that it has a 
similar function in milk or in whatsoever associations it is found. 

It is held by some that the catalases are not oxygen carriers, and in 
this connection Lesser (31) has shown that the decomposition of 
hydrogen peroxide by catalase does not lead to the oxidation of fat 
or carbohydrates. According to this author catalase is to be regarded 
as a substance capable of taking up oxygen and of giving it up again 
under certain circumstances. 

Peroxidases. — The idea that milk contains true oxidizing ferments 
or oxidases proper probably originated from the fact that in the 
earlier work on this subject old tinctures of guaiacum were employed 
in making the tests. As is well known, old tinctures of guaiacum 
frequently exhibit reactions which are not shown by the perfectly 
fresh tinctures (32). This has been accounted for on the supposition 
that on standing exposed to air and light substances of the nature 



347 

of peroxides are gradually formed in tinctures of guaiacum and that 
these substances react with the unchanged guaiacum in the presence 
of a peroxidase or suitable oxygen carrier, giving rise to the formation 
of guaiacum blue. On the other hand, there is abundant evidence 
at hand to show that milk contains substances capable of inducing 
the oxidation of guaiacum and other readily oxidizable substances 
by means of hydrogen peroxide or ozonized oil of turpentine. These 
substances are destroyed by boiling and are known as the peroxidases. 
A great many reagents have been proposed for the detection and 
approximate estimation of the peroxidases in milk, with the view, 
primarily, of distinguishing between fresh or raw and heated (pas- 
teurized) or boiled milk. Among these may be mentioned guaia- 
cum (33), potassium iodide, and starch (34), paraphenylene-dia- 
mine (35),ortol (36), paradiethyl-paraphenylene-diamine (3T),ursol 
(38), guaiacol (39), amidol (Leffmann) (35), phenolphthalin (40), 
benzidine (41), etc. These reagents are used in connection with 
small quantities of hydrogen peroxide or some peroxide compound 
such as the persulphates, perborates, or ozonized oil of turpentine, 
and with fresh unheated milk they all give characteristic changes of 
color which are not shown by milks which have been heated to 80° C. 
or higher. 

Whether the peroxidases of milk give rise to any changes in the 
composition of the milk can at present only be conjectured. It may 
be of course that they gradually effect the oxidation of reducing 
substances in the milk. According to some authors they gradually 
disappear when the milk turns sour. It has been our experience, 
however, that they pass practically unchanged into the whey when 
milk curdles as the result of the lactic acid fermentation. In the 
present state of our knowledge the various tests which have been pro- 
posed for the peroxidases of milk are chiefly useful in enabling us to 
form an idea of the condition of the milk, whether it has been heated 
beyond certain temperatures or not, although according to Gillet 
(15) even normal fresh milks vary in the amounts of peroxidases 
which they contain, and this has also been our own experience with 
this reaction. 

Reductases. — According to Seligmann (42) raw milk possesses re- 
ducing properties; for example, it reduces Schar dinger's (43) reagent, 
which consists of a solution of methylene blue containing small 
amounts of formaldehyde. By some authors these reducing substances 
have been regarded as ferments, reductases, by others as due to 
bacteria, and by still others they have been looked upon as identical 
with catalase, the ferment in milk which decomposes hydrogen per- 
oxide. By the use of a weak alcoholic solution of methlyene blue, 
Smidt (44) claims to have been able to distinguish between the re- 
duction brought about by bacteria and that caused by ferments. This 



348 

author has shown that the reductases of milk are different from the 
catalase and superoxidase of milk and separable from these, the latter 
being soluble in water and salt solution, the former not. In recent 
communications Seligmann (45) points out that the reductases and 
peroxidases of cow's milk are not indentical. According to this 
author all processes of reduction occurring in fresh and sour milk are 
due to the action of bacteria and not to unorganized ferments. 

Cathcart (46) has also made a study of the reduction of Schar- 
dinger's reagent by fresh milk. According to this author the reduc- 
tion of the coloring matter is due to the presence of a catalase which 
is readily destroyed by heat. Our knowledge, therefore, of the 
reductases of milk is at present very limited, and we are not as yet 
in a position to say whether they are responsible for any of the 
changes ordinarily occurring in milk. 

Part II. — (3) Changes in Milk Brought About by the Action of the Digest- 
ive Ferments — The Rennin Coagulation of Milk. 

The composition of milk is profoundly altered during the process 
of digestion through the action of the digestive ferments. In the 
stomach and intestine the fat is hydrolysed by lipase, giving rise to 
fatty acids and glycerin, the milk sugar is converted into glucose 
and galactose by lactase, and the proteids into simpler and more dis- 
fusible nitrogen compounds by the proteolytic ferments. Chief 
among these proteids is caseinogen, which, according to Lehmann and 
Hempel (1), has the following composition: 

Per cent. 

Carbon 54. 

Hydrogen 7.04 

Nitrogen 15.6 

Sulphur . 771 

Phosphorus . 847 

The following, according to Mann (2), are the principal dissocia- 
tion products which have been isolated from caseinogen by hydro- 
lytic cleavage: 

Per cent. 

Glycocoll 

Alanin . 9 

Leucin 10. 5 

Phenylalanin 3. 2 

Alpha-pyrrolidin carboxylic acid 3.2 

Glutaminic acid 10. 7 

Aspartic acid 1. 2 

Cystin .065 

Serin .43 

Oxy-alpha-pyrrolidin carboxylic acid . 25 

Tyrosin : 4. 5 

Lysin 5. 8 



349 

Per cent. 

Histidin 2.6 

Arginin 4.84 

Tryptophane 1.5 

Ammonia 1.8 

Cystein 

Amino valerianic acid 1. 

Glucosamin 

Diamino-trioxy dodecanoic acid . 75 

According to this author the absence of glycocoll and the carbo- 
hydrate radical and the relatively high ty rosin and tryptophane 
content of caseinogen render it especially readily digestible. It 
seems also to be the only native albumin which is attacked by erepsin 
(see Cohnheim (3)), and on account of its ease of hydrolysis it 
probably plays a special port in metabolism. In this connection 
Tunnicliffe (4) has shown that when total digestibility is considered 
human milk is much more digestible than any of its substitutes. 

Among the various changes brought about in the composition of 
milk through the action of the digestive ferments the most typical 
and characteristic is the rennin coagulation. Exclusive of the 
mineral matter the caseinogen is the only constituent of the milk 
involved in this change. 

It has long been known that fresh milk coagulates in the stomach 
of higher animals, and that an aqueous extract of the inner lining 
of the stomach of the calf, when added to fresh milk, causes it to 
curdle, whereby it clots or sets in the form of a solid curd. Since 
early times this fact has been turned to practical account in the 
making of cheese. The earlier explanations of the rennin coagu- 
lation of milk were based on an observation by Fremy (5) to the 
effect that rennet, or the mucous lining of the calf's stomach, has the 
power of converting milk sugar into lactic acid. According to 
Liebig (6), therefore, rennin curdles milk for the reason that it acts 
upon the milk sugar, converting it into lactic acid. The latter then 
neutralizes the alkali of the milk which holds the caseinogen in 
solution, thereby precipitating this substance as the curd. 

Soxhlet (7) also saw in the curdling of milk by rennin an analogy 
to the coagulation of milk by acids. According to him the former 
process took place much more rapidly than the latter. He held 
with Liebig that the rennin converted the sugar of milk into lactic 
acid and that this in turn converted the alkaline phosphate existing 
in the milk into an acid phosphate, which in turn precipitatel the 
casein. Hallier (8) explained the rennin coagulation of milk as due 
to the presence of micro-organisms in the stomach of the calf. The 
most important of the earlier observations on the curdling of milk 
by rennin was that made by Heintz (9), who showed that contrary 
to previous teachings on the subject the acqueous extract of the 



350 

mucosa of the calf's stomach has the power of curdling milk in both 
acid and alkaline solutions. To Hammarsten (10) and Schmidt (11), 
however, belong the credit of first showing that the rennin curdling 
of milk is accomplished by means of a soluble ferment to which they 
gave the name of " labferment " or " chymosin." This is the fer- 
ment which in English is called rennin, formerly rennet. Hammar- 
sten succeeded in showing: first, that the curdling of the milk by 
rennin is independent of the action of lactic acid; second, that the 
caseinogen (casein) of milk is not in true solution in milk but in 
colloidal suspension (gequollenen Zustande) ; third, that without 
the presence of a sufficient quantity of calcium phosphate rennin 
coagulation will not take place; fourth, that the caseinogen is so 
modified through the action of the rennin that in the presence of a 
certain quantity of a lime salt it can no longer remain in solution, but 
is precipitated as casein (Kase) or paracasein calcium phosphate; 
fifth, that as the result of the action of rennin, caseinogen (casein) 
is split into at least two new proteids, casein (der Kase) and whey- 
proteid (Molkeneiweiss). The former contains a relatively small 
quantity of calcium salts and is insoluble, the latter contains a larger 
proportion of calcium salts and is easily soluble. Finally Ham- 
marsten held it to be highly probable that the rennin coagulation 
of milk is analogous in many respects to the coagulation of fresh 
milk by heat, which occurs at 130° to 150° C, and that in this regard 
the action of rennin is similar to other fermentations. According 
to Hammarsten, therefore, the rennin coagulation of milk resolves 
itself into two distinct phases: (1) the conversion of caseinogen 
into paracasein in the presence of calcium salts, (2) the precipitation 
of paracasein from its solutions through the action of calcium salts. 
It will be observed that the second phase of the coagulation is inde- 
pendent of the action of rennin. 

These earlier researches by Hammarsten on the rennin coagulation 
of milk have been the point of departure for the greater number of 
subsequent investigations in this field, and his conclusions respecting 
this process have been the subject of a great deal of discussion. 

During recent years the rennin coagulation of milk has been studied 
by many observers. Among these may be mentioned Duclaux, Cou- 
rant, Lorcher, Fuld, Laqueur, Loevenhart, and others. As the result 
of his studies on the rennin coagulation of milk, Loevenhart (14) 

a The name caseinogen is employed throughout this communication on the 
rennin coagulation of milk in the sense in which it was first used by Hallibur- 
ton (12), namely, as signifying the proteid of milk, which, through the action a»f 
rennin in the presence of certain calcium salts, is transformed into the casein 
(paracasein) of the curd. The term paracasein was first introduced into the 
science by Schulze and Rose (13) and is used in the sense employed by Ham- 
marsten. 



351 

recognized essentially three distinct phases of the process : (1) Trans- 
formation of caseinogen into paracasein; (2) alteration or rearrange- 
ment of the mineral constituents of the milk, whereby the calcium 
salts become available for the coagulation; (3) precipitation of the 
paracasein by calcium salts. He has shown that the conversion of 
caseinogen into paracasein proceeds somewhat more rapidly than the 
rendering available of the calcium salts. According to this author 
the first two phases of the process are accomplished by the action of 
rennin, whereas the third phase, namely, the precipitation of the para- 
casein, is entirely independent of the action of the ferment. 

He also arrived at the conclusion from his study of the influence of 
salts on the coagulation of decalcified milk that the facts observed 
seemed to favor the theory that the curdling of milk depends in great 
part, though not entirely, on the rearrangement or rendering availa- 
ble of its mineral constituents. He succeeded in showing that fresh 
milk can not precipitate paracasein solutions nor can it prevent their 
precipitation by calcium chloride. Hence it would seem that the 
calcium salts of fresh milk are in some way altered through the action 
of rennin, thereby becoming capable of precipitating paracasein. 
He concludes therefore that in the rennin coagulation of milk the 
rennin has the power in some way to render available the calcium 
salts (die calcium Salze frei zu machen), since without this change 
no coagulation is possible. Similarly Briot (15) maintains that 
rennin acts less on the caseinogen than on the calcium phosphate of 
milk. While this extreme view is probably incorrect it is certain that 
the majority of chemists are agreed regarding the necessity of cal- 
cium salts for the rennin coagulation of milk. That such is the case 
is evident not only from the earlier investigations of Hammarsten 
but also from later and more exact observations by Arthus and Pages 
(16), Courant (17), Einger (18), Loevenhart (14), Edmunds (19), 
Benjamin (20), Soldner (21), Laqueur (22), and others. 

It has also been established by the work of Courant (17) that the 
reaction of milk is not altered during the rennin coagulation. 

The question still remains to be considered, How does the rennin 
act on the caseinogen and in what way is the latter altered through 
the action of the ferment? These questions have been exhaustively 
considered by Laqueur (23), who has arrived at the conclusion that 
from the slight differences between caseinogen and paracasein thus 
far made out it is impossible to arrive at an unequivocal explana- 
tion of the coagulation of milk by rennin. This author is inclined 
to believe, however, that Hammarsten's original explanation of the 
process is perhaps, all things considered, the best we have. Accord- 
ing to this explanation the rennin acts by splitting the caseinogen 
into a larger molecule, paracasein, and a smaller molecule, the whey- 
proteid (molkeneiweiss), also called hemicaseinogen albumose (Arthus 



352 



and Pages). Fuld (24) has recently suggested the name whey- 
albumose for the soluble proteid produced in the rennin coagulation 
of milk. This view also derives support from the more recent 
researches on the subject by P. T. Muller (25), who found whey- 
proteid in the milk serum only after rennin coagulation and not 
after the milk had been coagulated by acids or lactoserum. Simi- 
larly, unpublished analyses by W. Laqueur (23) and an experiment 
by Rotondi (26) also indicate the splitting off of a soluble nitroge- 
nous compound from caseinogen during the rennin coagulation of 
milk. On the other hand, according to Duclaux (27), who analyzed 
the filtrates obtained by filtering fresh milk and milk coagulated by 
rennin through a porcelain filter, the soluble nitrogen in the whey 
is not increased after rennin coagulation, nor is the composition of 
the whey altered in any way. That such is the case may be seen 
from the following results of his analyses of milk serum before and 
after coagulation by rennin: 





Experiment I. 


Experiment II. 




Normal 
milk. 


Milk coag- 
ulated by 
rennin. 


Normal 
milk. 


Milk coag- 
ulated by 
rennin. 


Lactose 


5.53 

.55 
.54 


5.53 
.57 
.52 


5.37 
.37 
.56 


5.64 




.36 




40 







Arrhenius (28) is of the opinion, however, that Duclaux's experi- 
ments on this point are not convincing, since the whey proteid might 
have been retained by the porcelain filter, especially in the presence 
of the gelatinous paracasein. 

From his researches on the laws governing rennin coagulation Fuld 
(29) also arrived at the conclusion that the transformation of case- 
inogen into paracasein is only a molecular rearrangement, partaking 
of the nature of a monomolecular process. According to this author 
the rennin coagulation of milk is only a special case of the well-known 
phenomenon of the reciprocal suspension and precipitation of col- 
loidal substances. Loevenhart (14) has also reached the conclusion 
that it is probable that caseinogen and paracasein are chemically the 
same substance, and that the observed differences existing between 
them depend upon the fact that paracasein exhibits a higher degree of 
association than caseinogen. In other words, paracasein consists of 
larger molecular aggregates than caseinogen, otherwise they are 
identical. These views are shared by other observers, among them 
Van Slyke and Hart (30) . On the other hand, Laqueur (23) , from a 
consideration of these facts and the conduct of other colloidal sub- 



353 

stances, comes to exactly the opposite conclusion, viz, that caseinogen 
is probably a higher colloid than paracasein. 

According to Laqueur (23) , the idea that paracasein is a more com- 
plex substance than caseinogen has also received support from 
Danilewski's observation that rennin gives rise to a precipitate in 
solutions of albumoses. According to the Russian investigators, by 
whom this reaction has been extensively studied, this precipitate pos- 
sesses the properties of a higher proteid. They therefore see in this 
change the synthesis of a complex substance having the nature of 
naturally occurring proteids from the products of assimilation, and 
find a ready explanation for the widespread occurrence of rennin in 
the tissues of animals and plants which are in no wise concerned with 
the digestion of milk. On the other hand, Laqueur (23) is inclined 
to question the validity of these conclusions. According to this 
author the weightiest objection that can be urged against these views 
is that at present we have no exact means of knowing whether the 
reaction resulting in the formation of these plastein substances, as 
they have been called, is really the result of rennin action and whether 
Ave have a right to ascribe to these changes the same cause as that 
which brings about the conversion of caseinogen into paracasein in 
the coagulation of milk. We know that as yet we have no means of 
operating with the pure ferment, but that in a solution of ferments 
the ferment itself often composes only a small part of the mixture, 
and in this connection it has been found that whereas one part by 
weight of the ferment solution is required to convert 48 grammes of 
albumose into plastein the same quantity of the ferment solution 
will convert from 10,000 to 100,000 grammes of caseinogen into para- 
casein. Hence, according to Laqueur (23), it would seem to be a far- 
fetched conclusion to ascribe these two changes to the same ferment. 
It is therefore a mistake, according to this author, to assign to a 
ferment so widely distributed in plants and animals as that causing 
the plastein reaction a function absolutely identical with that of the 
ferment contained in the stomach of the calf, the latter producing 
the typical rennin coagulation of milk, until it has been definitely 
established that the ferment from plants, etc., also acts on caseinogen 
in two stages, in one of which calcium salts are required, and that 
the paracasein produced in the two processes is the same in each. 
Other chemists are also of the opinion that the plastein reaction is in 
reality due to pepsin and not to rennin at all. 

As a matter of fact the chemical and physical differences between 
caseinogen and paracasein are apparently so slight and in the pres- 
ent state of our knowledge so imperfectly understood that it is im- 
possible to decide between all of these conflicting views on the rennin 

45276°— Bull. 56—12 23 



354 

coagulation of milk. Laqueur (23) takes the view, however, that 
the hypothesis that rennin causes a coagulative splitting of caseino- 
gen rests at least upon some foundation of fact, whereas the view 
that rennin exerts a synthetic action rests at present upon very 
deceptive analogies and teleological evidence. 

The more one studies the extensive literature of the rennin coagu- 
lation the more one is disposed to agree with Laqueur that in the 
present state of our knowledge it is impossible to arrive at an une- 
quivocal explanation of this complicated process. It seems, how- 
ever, to have been reasonably well established — 

(1) That, exclusive of phosphates of calcium and other soluble 
salts of calcium, caseinogen is the only substance in milk involved 
in the rennin coagulation. 

(2) That in the rennin coagulation of milk no change of reaction 
occurs; that is, no production of base or acid. In this connec- 
tion it has been pointed out by Herwerden (31) that hydrogen ions 
are not necessary for the rennin coagulation of milk or of solution 
of caseinogen containing calcium. 

(3) That in the rennin coagulation of milk two active agents are 
concerned, a soluble ferment, rennin, and calcium ions ; that is, solu- 
ble calcium salts. 

According to Hammarsten the caseinogen is resolved by rennin 
into paracasein and whey proteid. Through the action of calcium 
ions (soluble calcium salts), the former is then precipitated as the 
curd (Kase), the latter remaining in solution. According to Fuld 
and others the change of caseinogen into paracasein is a molecular 
rearrangement. According to Courant the dicalcium caseinogenate 
is so altered by rennin that by contact with soluble calcium salts a 
precipitate (the curd) is produced. According to Lovenhart the 
rennin renders the calcium salts of milk available for the coagulation 
of paracasein, which latter is formed from caseinogen also by the 
action of rennin, and which, according to this author, differs from 
caseinogen only in that it is composed of larger molecular aggregates. 
It will be observed that these several views regarding the precise 
mode of action of the rennin differ in some particulars. These dif- 
ferences can only be reconciled by further investigation. 

It has been shown by Soldner (32), Osborne (33), Courant (17), 
and others that caseinogen is an acid. According to Courant it forms 
three kinds of salts, namely, mono-, di-, and tri-caseinogenates. It 
also seems probable from Lehmann's (1) investigations that the 
caseinogen exists in fresh milk in the form of a complex calcium 
salt containing calcium phosphate. According to this author the 



355 

composition of this compound agrees reasonably well with the 
formula 

Ca 3 (POJ 2 Ca. caseinogen. 

According to Courant (IT) a solution can be obtained showing 
essentially the same alkalinity to lacmoid and the same acidity to 
phenolphthalein and conducting itself to rennin in the same manner, 
as fresh milk, by bringing together, lime water, caseinogen, and 
phosphoric acid in the quantities indicated in the following equation : 

/OH /OH 

6 Ca(OH) 2 +2 Cas-OH+ 4 H 3 P0 4 =Ca 3 (P0 4 ) 2 +2 Cas-0\ n . 
\OH \0/ Ua + 

Ca (H 2 P0 4 ) 2 +12 H 2 0. 

In other words, the mixture or compound 

/OH 

[Ca 3 (P0 4 ) 2 +2Cas-0 >Ca +Ca(H 2 P0 4 ) 2 ] 

closely approximates the condition of the caseinogen and phosphates 
as these substances exist in fresh milk. Whether these several 
substances are merely intimately mixed together or whether they 
form some loose chemical combination similar to a complex double 
salt can not be definitely determined at present. According to 
Courant, however, all of these substances are necessary to the rennin 
coagulation, namely, dicalcium caseinogenate, soluble calcium salts, 
represented in the equation by monocalcium phosphate, and also 
tricalcium phosphate. According to this author only the dicalcium 
caseinogenate is altered in the rennin coagulation of milk, this being 
converted into paracasein. According to him the role of the soluble 
salts of the alkaline earths (calcium) in this process is simply to 
diminish the solubility both of the caseinogen itself and the para- 
casein. This last notion is in harmony with certain observations by 
Ringer (18), who found that even fresh milk is coagulated by warm- 
ing Avith small amounts of calcium salts. According to this author 
three drops of a solution of calcium chloride are sufficient to curdle 
ten cubic centimeters of fresh milk at 70° to 75° C. He further 
observed that while a very slight acidity seems to favor the coagula- 
tion by calcium salts it is by no means essential to the process, since 
it can be brought about even in faintly alkaline milk. 

Finally, in the presence of soluble calcium salts the paracasein 
resulting from the action of rennin is precipitated in the form of an 
insoluble calcium salt containing calcium phosphate, either in loose 



356 

chemical combination or as an intimate mixture. In this connection 
it has been shown by Harris (34) that in the curdling of milk by 
rennin 13 per cent more calcium phosphate is used up than in the 
acid coagulation of milk. 

In this connection Courant's (17) views regarding the composition 
of milk and the manner in which the caseinogen is held therein afford 
the most satisfactory explanation of the conduct of fresh milk toward 
chemical indicators. To review this subject briefly, Courant has 
found that cow's milk and caseinogen solutions, such as that whose 
composition is given in the above equation, react alkaline to lacmoid 
and acid to phenolphthalein. The acidity of fresh cow's milk proved 
to be slightly less than that of the caseinogen solutions; the alkalin- 
ity of milk, on the other hand, was nearly twice that of the caseinogen 
solutions. He reaches the conclusion that one half of the acidity 
toward phenolphthalein as shown by cow's milk and his caseinogen 
solutions is due to the acidity of dicalcium caseinogenate, and the 
other half to monophosphates. In this calculation he purposely neg- 
lects the slight acidity of milk due to the free carbonic acid which 
it contains. The alkaline reaction toward lacmoid depends in the 
case of the caseinogen solutions partly on the dicalcium caseinogen- 
ate, which, like the salts of other weak acids, is readily hydrolyzable, 
yielding a certain amount of free base, namely, calcium hydroxide, 
and partly on the insoluble phosphates. In the case of milk the 
alkalinity toward lacmoid depends on these two factors and also on 
the presence of diphosphates. The greater alkalinity of cow's milk 
depends partly on the larger quantity of insoluble phosphates pres- 
ent, but principally on the presence of diphosphates. As has been 
repeatedly shown, human milk is more alkaline than cow's milk. 
According to Courant, however, it, like cow's milk, is also acid to 
phenolphthalein and alkaline to lacmoid. In the case of cow's milk 

he found the ratio of alkalinity to acidity to be —-^-=2.1, and in the 

1 08 
case of woman's milk ^^=3. According to this author the rela- 
tively slight acidity of woman's milk is due to the small quantity of 
caseinogen which it contains and also in all probability to the fact 
that it contains its caseinogen in the form of tricalcium caseinogenate. 
To return for a moment to the subject of the rennin coagulation of 
milk, it would seem that certain aspects of this change exhibit an 
analogy to the action of a toxin. It has been shown, for example, 
by Hammarsten and Roden (35) that normal horse serum contains 
a substance capable of inhibiting the action of rennin. In other 
words, it contains an antirennin. Similarly, by repeated injection 



357 

of small amounts of rennin into the blood of animals, Morgenroth 
(36) obtained an antirennin. According to Fuld and Spiro (37) the 
antirennin of normal horse serum prevents the coagulation of milk by 
binding the calcium ions. Arrhenius is therefore of the opinion that 
in these reactions rennin coresponds to the toxophorous group, the 
calcium ions to the haptophorous group of a toxin, and the antirennin 
to an antitoxin. 

Many additional facts concerning the rennin ferment are known. 
Like other ferments, it is affected by heat, and the rate of the rennin 
coagulation is determined both by the quantity of rennin acting and 
by the temperature. It has been shown that the ferment can with- 
stand a temperature of —180° C. without injury. At temperatures 
higher than 44° C. the ferment gradually loses its activity, and expo- 
sure to a temperature of 50° to 60° C. for a considerable time has been 
found to be more harmful- than a short exposure to a higher tempera- 
ture. The effect of temperature is also determined by conditions sur- 
rounding the ferment, whether it is moist or dry, and also by the 
reaction of the solution containing the ferment. In the dry state it 
can withstand a temperature of 100° to 140° C. Its destruction by 
heat has been found to follow the law for a monomolecular reaction. 

The influence of temperature on the rennin coagulation has been 
studied by Fuld (29). Some of his results are given in the following 
table : 



Temperature ° (C). 


Time (sec). 


k, observed. 


k, calculated. 


25. 05 


54 
32 
17 

10.2 

9 

14.7 


185 
312 
588 
980 
1,111 
680 


185 


30 


327 


35 


574 


40 


980 


44 


1,491 
2,742 


50 





(The values of k, observed equal 10,000 divided by time.) 

It will be observed that there is a good agreement between the 
observed and the calculated values up to 40° C. Above this tem- 
perature the observed values of k become smaller than the calculated 
values on account of the gradual destruction of rennin by heat. 

In 1870 Segelke and Storch (38) showed that rennin coagulates 
milk in intervals which are inversely proportional to the concentra- 
tion of the rennin solution. This conclusion has been confirmed by 
the later work of a number of observers. Thus Lorcher (39) obtained 
the following results from his measurements; 



358 



Quantity 

of rennin, 

in ec. 


Time of co- 
agulation, 
minutes. 


Product. 


0.01 
.02 






245 


490 


.03 


155 


465 


.04 


126.5 


485 


.05 


92 


460 


.06 


78 


468 


.07 


69.25 


485 


.08 


63 


504 


.09 


56 


604 


.10 


43 


430 


.20 


24.5 


490 


.30 


16 


480 


.40 


12.5 


500 


.50 


10 


500 


.60 


8.75 


525 


.70 


8.16 


561 


.80 


7.5 


600 


.90 


6.7 


603 


1.0 


6. 


600 



Eecently Madsen (40) has also investigated the effect of concen- 
tration of the rennin on the rennin coagulation, working at a tem- 
perature of 36.55° C. The following are the results of his measure- 
ments : 



Time 
(minutes). 


Rennin 
(grams). 


Product. 


4 


0.08 


0.32 


6 


.05 


.30 


9 


.033 


.30 


11 


.024 


.26 


12 


.019 


.23 


14 


.0175 


.25 


20 


.013 


.26 


25 


.01 


.25 


30 


.007 


.21 


35 


' .007 


.25- 


50 


.005 


.25 


70 


.004 


.28 


80 


.0032 


.26 


100 


.0028 


.28 


120 


.0025 


.30 


180 


. 00185 


.33 


240 


.0017 


.41 



The influence of various other factors, such as the reaction of the 
milk, the action of salts, the effect of ultraviolet rays, and the action 
of various organic substances on the rennin coagulation of milk has 
also Been the subject of numerous investigations. It is ofttimes a 
difficult matter to determine whether these various influences are 



359 

exercised toward the ferment itself or whether they react on the milk 
or participate only in the second phase of the rennin coagulation. 
The further consideration of such agents is beyond the scope of this 
communication. Before leaving the subject, however, it should be 
observed that Hillman (41) has studied the rennin coagulation of 
milk in its practical aspects. This author has found that the milk 
of fresh cows is better suited to the rennin coagulation than the milk 
of cows which are nearly dry. In his opinion this is probably to be 
explained by the diminution in the calcium content of milk during 
the period of lactation. He found, further, that the degree of acidity 
of milk in relation to the calcium content is an important factor. 
According to this author a high calcium content and high acidity 
prevail at the beginning of lactation and are usually accompanied 
by high total albumin and a high caseinogen content, all of which 
conduce to a large yield of paracasein. He also finds that the time 
of coagulation and the yield of paracasein are independent of one 
another; generally, however, a short coagulation time and a large 
yield of paracasein are associated. Strong dilution of the milk 
with water tends to diminish the yield of paracasein, whereas the 
addition of soluble calcium salts tends to increase it. 

According to this author the action or rennin consists not only in 
the splitting of caseinogen into paracasein and whey proteid, but also 
in the conversion of other milk proteids into more soluble form. He 
seems to think that under favorable conditions paracasein may be 
formed from the albumin as well as from the caseinogen. 

Paet II. — (4a) Chemical Changes in Milk Pkoduced by Bacteria and Various 

Other Micro-organisms. 

The more obvious changes in milk with which we are familiar 
are those that are brought about by bacteria and various other 
micro-organisms. Among these changes may be mentioned: The 
ordinary souring and curdling of milk, with the production of lactic 
acid as the chief product; the production in milk of various odor- 
iferous or highly flavored substances, many of a somewhat dis- 
agreeable character, good examples being met with in the ripening of 
cream and cheese; the production of colored substances which im- 
part to the milk unusual colors, such as the formation of blue milk ; 
the formation of mucilaginous, or mucin-like substances, which serve 
to impart to the milk a characteristic ropiness, known as ropy milk, 
and finally we must include under this head those bacterial changes 
in milk which result in the formation of poisonous substances, such as 
tyrotoxicon, toxins, etc. 

The lactic acid fermentation of milk. — The lactic acid fermentation 
is the commonest and best known of all the many bacterial changes 



360 

that occur in milk. The fact that on standing at ordinary tempera- 
tures milk gradually turns sour and finally curdles has been known 
ever since milk was first used as a food by man. In early times the 
acid of milk was supposed to be acetic acid, the same as is present 
in vinegar, and as has already been pointed out this acid does, accord- 
ing to Bechamp ( 1 ) , occur in even freshly drawn milk in small quan- 
tities. The substance really responsible for the souring of milk, how- 
ever, viz, lactic acid, was first discovered in milk by Scheele in 1780. 
The new acid was also studied by Berzelius, and its composition 
definitely established through the work of Mitscherlich and Liebig in 
1832. Its chemical constitution and its relation to other varieties of 
lactic acid, occurring in nature or the products of chemical synthesis, 
were first established by the labors of Strecker, Erlenmeyer, and 
Wislecenus. 

In 1847, Blondeau (2) discovered micro-organisms in sour milk, 
but attached to these no particular significance so far as the souring of 
milk is concerned. It remained for Pasteur (3), in 1857, to definitely 
and conclusively show as one of the results of his classic investigations 
on fermentation that the souring of milk is really a kind of fermenta- 
tion, which is accomplished by a peculiar kind of micro-organism, to 
which he gave the name of levure lactique (lactic yeast). His first 
communication on this subject was read to the Scientific Society of 
Lille, August, 1857, and afterwards to the French Academy in No- 
vember, 1857. Since then our knowledge of the lactic acid fermenta- 
tion has been considerably extended through the labors of Pasteur's 
students, and still later through the work of other bacteriologists and 
chemists. For example, Boutroux (4) in 1878, in continuing the in- 
vestigations of Pasteur on the souring of milk, arrived at the conclu- 
sion that the lactic acid ferment and the mycoderma aceti, which is 
concerned in the transformation of alcohol into acetic acid in vinegar 
making, are identical, but that these vary in function, depending on 
their general environment and the composition of the liquid in which 
they grow. This communication also contains a description of the 
lactic ferment and an enumeration of its morphological characteris- 
tics, which are beyond the scope of the present communication. He 
observed that the organism grew best in a nutrient medium con- 
taining, besides albuminous matter, invert-sugar or glucose. He also 
found that under these conditions the liquid can attain a maximum 
acidity of 1.5 per cent lactic acid. Larger amounts of acid than this 
checked the life and growth of the organism, and hence if it is desired 
to convert all of the sugar into lactic acid the acid must be neutralized 
with chalk or zinc carbonate as fast as formed. Under proper con- 
ditions the lactic acid organism employed by Boutroux produces lactic 
acid only. 



361 

The lactic acid fermentation of milk sugar was also investigated by 
Kichet (5), who found that when milk is kept at 40° C. it becomes 
acid and coagulates and finally attains an acidity of 1.6 per cent, 
which amount it never exceeds. He made the further interesting 
observation that if gastric juice be added to milk the casein is coagu- 
lated and finally dissolved, and in less than twenty-four hours the 
milk contains a larger quantity of lactic acid than otherwise would 
have been produced in a weeft, and after four or five days as much as 
4 per cent of lactic acid was formed. He observed that while neither a 
pure solution of lactose nor gastric juice will ferment, if the two be 
mixed fermentation takes place; and that the casein of milk after it 
has been dissolved by gastric juice also ferments, yielding lactic and 
butyric acids, besides other products of fermentation. On the other 
hand, the whey of milk obtained by coagulation with rennin never 
attains an acidity greater than 1.6 per cent of lactic acid, even after 
having been kept for six months. He found that. the lactic acid 
fermentation is increased by exposing a large surface of the milk to 
the air. The activity of the ferment increases up to 44° C, remains 
constant between 44 and 52° C., and above 52° C. diminishes in 
activity as the temperature rises. Digestive juices and peptones 
were found to aid lactic fermentation, but leucine and glycocoll 
were found to have no effect upon the process. 

The general trend of more recent investigations on the subject of 
lactic acid fermentation has been to show that the change of milk 
sugar into lactic acid takes place under the influence, either direct or 
indirect, of a whole series of micro-organisms, whose number has been 
considerably augmented by recent investigations in this field. Marp- 
mann (6), for example, during the summer of 1885 investigated the 
micro-organisms of cow's milk in the neighborhood of Goettingen 
and detected five seemingly new and different species of organisms 
which more or less strongly induce the lactic acid fermentation in 
solutions of cane sugar and also in milk. 

Leaving out of consideration the levure lactique of Pasteur, the first 
of these organisms whose morphological and biological character- 
istics seem to have been determined with sufficient accuracy is the 
Bacillus acidi lactici of Hueppe (7). It is now known that in addi- 
tion to the Bacillus acidi lactici (Hueppe) the following organisms 
can bring about the lactic acid fermentation, viz, Bacillus aerogenes, 
Bacillus coli. Bacillus lactis acidi (Leichmann and others) , Strepto- 
coccus lacticus (Kruse), Streptococcus pyogenes, Pneumonococcus A 
and Pneumonococcus B, Bacillus Delbruecki (Leichmann), Bacillus 
acidificans longissimus (Lafar), etc. 

Beyerinck (8) has also made exhaustive studies of the lactic acid 
ferments employed in the arts. This author applies the name 
Lactobacillus Delbruecki to all species of the lactic-acid ferment 



362 

which can be isolated by the gelatin-must method. These organ- 
isms, according to this author, however, are not the active agents of 
a good industrial ferment. On the other hand, from such a ferment 
he was able to isolate the Lastobacillus fermentans. This organism 
when cultivated under good conditions yields only lactic acid and no 
volatile acids. The minimum temperature of its activity he found 
to be 25° C, the optimum temperature 41°-42° C., and the maximum 
temperature 50° C. These observations furnish an interesting con- 
firmation of the earlier work of Kichet so far as the influence of 
temperature on the lactic fermentation is concerned. According 
to Beyerinck the lactic organisms studied by him can be mutually 
transformed into one another by cultivation. 

Heinemann (9) has called attention to the similarity existing 
between Bacillus acidi lactici (Hueppe #nd others) and Bacillus 
(lactis) aerogenes (Escherich) and also to the similarity of Bacillus 
lactis acidi (Leichmann and others), Streptococcus lacticus (Kruse) 
and Streptococcus pyogenes, and in a more recent communication 
(10) on the kinds of lactic acid produced by lactic acid bacteria, to 
the similarity of Streptococcus lacticus with Streptococcus pyogenes 
and of Bacillus acidi lactici with Bacillus aerogenes. It has been 
observed by this author that in the ordinary souring of milk, lactic 
acid is produced chiefly by Streptococcus lacticus and Bacillus aero- 
genes, and further, that the former organism predominates in ap- 
proximate proportion to the purity of the milk. Conn (11) also has 
shown that 95 to 100 per cent of all organisms in sour milk are of 
the Bacillus lactis acidi type (Streptococcus lacticus). 

It is now known that lactose (sugar of milk) is not directly fer- 
mentable, but must first be converted into the simpler sugars glucose 
and galactose. It has been shown by a number of investigators that 
many yeasts and bacteria produce an enzyme which is capable of 
effecting this hydrolysis, and Hirschfeld (12) has shown that in the 
souring of milk the lactic acid bacteria accomplish the inversion of 
lactose, and that this change takes place most rapidly in the first 
thirteen to twenty- four hours after the introduction of the organisms 
into the milk, the relative amounts of lactose inverted being: First 
day, 0.16 ; second day, 0.23 ; third day, 0.29. Finally in this connec- 
tion it has been shown by Buchner and Meisenheimer (13), and inde- 
pendently by Herzog (14), that an enzyme can be extracted from 
certain of the lactic-acid-forming bacteria, which in the absence of 
organisms is able to transform lactose and cane sugar into lactic acid. 
Buchner and Meisenheimer extracted the ferment from Bacillus Del- 
bruecki (Leichmann), whereas in his experiments Herzog employed 
the Bacterium acidi lactici. On the other hand Beyerinck (8) is of 
the opinion that the production of lactic acid by the lactic acid 
bacteria is not a mere enzymic function, but a catabolic process. 



363 

The kinds of lactic acid produced in milk by the lactic acid bac- 
teria. — As is well known, 4 isomers of lactic acid exist. Three of 
these are stereo-isomers of alpha- oxy-propionic acid or ethylidine 
lactic acid, the chemical structure of which is represented by the 
formula 

CH 3 .CHOH.COOH. 

This compound, as indicated by the above formula, contains one 
asymmetric carbon atom, viz, the central one, and hence two optically 
active forms of lactic acid and one optically inactive form composed 
of equimolecular proportions of the two active varieties are possible 
and all three are known to exist. Aqueous solutions of one of these 
forms of lactic acid rotates the plane of polarization to the right, the 
second active variety rotates it to the left, and the third inactive 
form has no effect on the plane of polarization. Hence the first 
acid is called dextrolactic acid, and is designated as the d-lactic acid 
or simply d-acid; the second is called laevo-lactic acid and is desig- 
nated as 1-lactic acid or 1-acid ; and the third lactic acid of the above 
formula is called inactive or racemoid lactic acid and is designated 
(d + 1) lactic acid or sometimes r-acid. 

The fourth isomer of lactic acid has an altogether different chemical 
constitution from the other three forms of the acid and is known to 
chemists as beta-oxypropionic acid, hydracrylic acid, or ethylene 
lactic acid. It has the chemical structure represented by the formula 

CH 2 OH.CH 2 .COOH. 

This acid contains no asymetric carbon atom. It therefore ex- 
hibits no optical activity and only one form of it is known. This 
is not a product of the lactic acid fermentation, and hence does not 
further concern us in this connection. In the changes occurring in 
the fermentation of milk we are concerned with only the first 3 forms 
of the acid, viz, with the optical isomers of alpha-oxy propionic acid. 
Formerly it was generally accepted as pretty well established that the 
lactic acid produced in the souring of milk consisted mainly, if not 
entirely, of the r-acid. Indeed, ordinary lactic acid, viz, the r-acid, 
was frequently spoken of as fermentation " Gahrungs '.' lactic acid. 
In 1895, however, it was shown by Gunther and Thierf elder (15) 
that the lactic acid present in milk which has soured spontaneously 
does not always consist entirely of inactive lactic acid. They showed, 
in fact, that while the inactive acid was present in naturally sour milk 
there was often a preponderance of the dextro-rotatory acid. Fur- 
ther, the Bacillus lactis acidi (Streptococcus lacticus, Kruse) in pure 
lactose was found invariably to produce the d-acid. 

In this connection Gadamer (16) has observed that commercial 
lactic acid is either inactive or dextro rotatory. 



364 

Quite recently Heinemann (10) has made an exhaustive study of 
the kinds of lactic acid produced in milk by the lactic acid bacteria. 
The following are his conclusions : 

1. Milk naturally soured at room temperature contains chiefly d-acid. Milk 
soured at 37° C. contains chiefly r-acid with 1-acid in excess if allowed to stand 
several days. 

2. Streptococcus lacticus and Streptococcus pyogenes produce the same kind 
of lactic acid, i. e., d-acid. B. aerogenes from milk (B. acidi lactici) and the 
ordinary laboratory strain of B. (lactis) aerogenes (Escherich) produce the 
same kind of lactic acid, i. e., 1-acid. 

3. The lactic acid produced in naturally soured milk varies : 

(a) According to the relative numbers of Streptococcus lacticus and B. 
aerogenes present, the higher the number of B. aerogenes the more I-acid is 
produced. 

( &) According to the temperature at which the fermentation takes place, other 
conditions being equal, at 37° C. relatively more 1-acid is formed than at room 
temperature. 

(c) According to the length of time the fermentation has lasted, the longer 
the time the more 1-acid is formed. 

4. In " certified " milk, d-acid only was present at room temperature for nine 
days, while both d-acid and 1-acid were present in milk of poorer quality after 
one to four days. At 37° C. 1-acid was apparent after six days in " certified " 
milk and on the second day in other milk. It seems as if the purer the milk 
the longer the excess of d-acid persists. 

5. Racemic lactic acid is the result of the formation of pure d-acid and pure 
1-acid by at least 2 different species of micro-organisms. Racemic lactic acid is 
not known to be the product of one species only. 

6. Since it is known that B. aerogenes forms other acids besides lactic acid, 
often in appreciable amounts, while Streptococcus lacticus produces almost pure 
d-acid, the presence of d-acid may be taken as indicating desirable conditions 
for dairy work, because this shows the absence of the fermentation products of 
B. aerogenes, i. e., volatile acids, gas, and ethyl alcohol. 

According to Clafflin (17) in the lactic acid fermentation as carried 
out in the manufacture of the acid, in which process the acid pro- 
duced is neutralized by chalk practically as fast as formed (or at 
least never allowed to exceed 0.02 to 0.5 per cent by weight of the 
solution), 98 per cent of the sugar is converted into lactic acid in 
three to six days through the action of a pure culture of Bacillus 
acidi lactici. On the other hand, in the ordinary souring of milk, in 
which case of course no pains are taken to neutralize the acid as it 
accumulates in the liquid, smaller amounts of lactic acid are formed 
and much less than the total quantity of lactose present is changed. 
Thus we have seen from the earlier observations of Boutroux and 
Bichet that the lactic acid never exceeds 1.6 per cent by weight of 
the liquid undergoing fermentation, and according to recent observa- 
tions by Blumenthal and Wolff (18), milk which has been kept four 
years may still contain 50 per cent of its original lactose unchanged. 

It has also been found by Haacke (19) that the amount of lactic 
acid produced in the lactic fermentation never exceeds one-third of 



365 

the amount of sugar decomposed and that the quantity of acid present 
at any one time during the time of the fermentation is not strictly 
proportional to the amount of sugar decomposed, for the reason that 
a part of the lactic acid resulting from the decomposition of the 
sugar is in all probability decomposed into other substances. Accord- 
ing to this observer, 1,000 lactic bacilli decomposed in one hour an 
amount of sugar varying according to conditions from 0.00001 to 
0.008 milligram. 

The changes brought about in milk by micro-organisms are by no 
means confined to the production of lactic acid. In fact, as we have 
already seen, it is only by working with pure cultures of certain of 
the lactic acid organisms, such as the Streptococcus lacticus, etc., 
under proper conditions, that lactic acid alone is produced, and in 
the souring of milk, as this ordinarly takes place, a great many sub- 
stances besides lactic acid are produced in larger or smaller amounts. 
Among these may be mentioned acetic, butyric, and succinic acids, 
alcohol and gaseous substances, such as hydrogen and carbon dioxide. 
In addition to these substances may be mentioned the production 
of small amounts of substances having characteristic odors usually 
of a disagreeable character. 

It would seem from the recent work of Tissier and Gasching (20), 
carried on in Professor Metschnikoif's laboratory, that in the souring 
of milk, as this usually takes place, we have a more or less regular and 
definite sequence of changes, due to the growth and development in the 
milk of various species of micro-organisms which were always found 
by these observers to be present in the milk as it left the dairy. In 
the samples examined by them they found constantly bacteria and 
fungi. According to these authors the bacteria present in milk are 
divisible into two groups: 

First. Mixed ferments, including the proteolytic mixed, such as 
Staphylococcus, rather rare, and the peptolytic mixed, such as En- 
terococci, B. coli, B. acidi paralactici, and B. lactopropylbutyricus. 

Second. The simple ferments, including the simple proteolytic, such 
as Mesentericus, Subtilis, B. putrificus, and Proteus vulgaris; the 
simple peptolytic, such as Proteus Zukeri and B. foecalis alcaligenes. 

The fungi are oidium lactis, rhizopus nigricans, and in one case a 
lactose yeast. 

In sterilized milk these authors have found these organisms to pro- 
duce the following changes: 

The mixed ferments accomplish two principal fermentations in 
milk, the lactic and the butyric fermentations. The lactic fermenta- 
tion is brought about by enterococcus, less actively by B. coli and 
most actively and vigorously by B. acidi paralactici, which possesses 
a high order of resistance. It produces chiefly dextrolactic acid. 
The butyric fermentation is accomplished by only one species, viz, 



366 

B. lactopropylbutyricus, which in order of sequence follows in the 
wake of the lactic fermentation. It is only dependent on it indi- 
rectly, however, since for the growth and development of this organ- 
ism in milk neither lactic acid nor lactates are required, but a hexose 
which is formed from lactose by the bacteria immediately preceding 
the growth of the butyric ferment. Thus the butyric ferment 
depends only indirectly for its action on the lactic acid fermentation. 

The simple ferments of milk have been found to peptonize and 
destroy the casein, but in symbiosis with the mixed ferments they 
are rapidly arrested in their action by the acid reaction of the medium 
and become powerless to effect those changes in milk which they 
ordinarily can accomplish. For the completion of these changes, 
therefore, the intervention of higher organisms is necessary. These 
are accomplished by the milk fungi, oidium lactis, and rhizopus 
nigricans. 

The progress of the souring of milk has been found by these 
observers to be always the same. The mixed ferments develop rap- 
idly, aided by the simultaneous action of the simple ferments. En- 
terococcus has been found to be the species predominantly producing 
inactive lactic acid, valerianic acid, and also always acetic acid. 
B. coli follows in its action, producing laevo lactic acid. Together 
these two organisms give an acidity to milk equivalent to 1.47 to 2 per 
cent of sulphuric acid. This degree of acidity arrests the action of 
the proteolytic ferments and brings on the coagulation or curdling 
of the milk. The B. acidi paralactici continues the destruction of 
the lactose, however, and gives rise to the true lactic acid fermentation, 
producing always dextrolactic acid. The medium having become 
favorable for its growth and development, the Bacillus lactopropyl- 
butyricus sets up its characteristic fermentation, producing always 
inactive lactic and also propionic and butyric acids until a total 
acidity of 4 to 6 per cent in terms of sulphuric acid is reached. This 
degree of acidity arrests all bacterial action. The fungi, oidium lactis, 
and rhizopus nigricans then intervene, however, and by oxidizing the 
organic acids and lactose and by effecting a further destruction of the 
casein again favor the growth and multiplication of those organisms 
whose development has been momentarily checked. It also appears 
from the work of Tissier and Gasching that the simple ferments alone 
can bring about the decomposition of the casein and its ultimate deriv- 
atives. They have further observed that the bacteria ordinarily con- 
cerned in the souring of milk are not in any way directly responsible 
for the digestive disturbances which occasionally result from the use 
of milk as a food. Under certain conditions, however, they may act 
as predisposing causes, but the accidents of botulism are due, accord- 
ing to these authors, to special species of organisms differing from 
those which are ordinarily concerned in the souring of milk. 



367 

Quite recently Beyerinck (21) has again discussed the lactic fer- 
mentation of milk. He has found that temperature and oxygen 
pressure determine the nature of the autofermentation of milk. At 
temperatures below 40° C. the fermentation brought about by B. 
coli is replaced by a butyric acid fermentation, which, after lasting 
some time, is succeeded by a lactic acid fermentation. In good milk, 
even at 40° C., at which temperature gas-producing bacteria develop 
most rapidly, no gas is produced. This fact therefore forms the 
basis of a dairy test for judging of the purity of milk. He recog- 
nizes three forms of lactic acid fermentation depending on the tem- 
perature. At very low temperatures there occurs the slimy lactic acid 
fermentation, which, according to this author, is due to the smaller 
cell walls of the organism. At medium temperatures the common 
lactic acid fermentation predominates, this being caused by the lacto- 
coccus and at higher temperatures the lactic acid fermentation 
caused by the lactobacillus. Methods for isolating these organisms 
from milk are given, and also their morphological characteristics 
and their zymotic reactions. He, like other observers, has found the 
lactic acid ferment to be very variable. 

Eeference has already been made to the fact that the lactic acid 
fermentation of milk is used commercially in the manufacture of 
lactic acid. The lactic acid fermentation of milk is also turned to 
practical account in the manufacture of cheese. It has been shown 
by Epstein (22) that the ripening of cheese is due largely to the 
action of organisms which induce the lactic acid fermentation. 
Each particular kind of cheese is produced by the agency of special 
organisms which act chemically by means of enzymes and give rise 
to the peculiar odor and flavor of the cheese. These organisms are 
chosen both with regard to their power to induce the lactic acid fer- 
mentation and also with regard to the peculiar kind of cheese desired. 
Similar views regarding the ripening of cheese are held by Von 
Freudenreich (23). According to this author the lactic acid bacteria 
play the preponderating if not the exclusive role in the ripening of 
Emmenthaler cheese. Similarly Boekhaut and de Vries (24) have 
shown that cheese which does not contain the lactic acid bacteria 
does not ripen. On the other hand Chodat and Ho f man-Bang (25) 
are of the opinion that the importance of the lactic acid bacteria in 
the ripening of cheese has been overestimated, and attribute the 
greater number of the changes occurring in this process to another 
organism — namely, tyrothrix. 

In this connection it is interesting to note that Van Slyke (26) 
found that when only rennet is allowed to act on milk no cheese 
flavor is developed. 



368 

Abnormal fermentations of milk. — Under ordinary circumstances 
milk usually undergoes the lactic acid fermentation. It turns sour 
and curdles and the production of lactic acid puts a stop, tempora- 
rily at least, to all other bacterial changes. Hence in normal milk 
it is only rarely that fermentation other than souring occurs. Under 
certain conditions, however, the milk becomes infected with a great 
variety of micro-organisms and various changes in its composition 
are brought about. By some authorities these have been called 
abnormal fermentations. As a result of these fermentations, altera- 
tions take place in the color, odor, and taste of the milk, and in some 
instances highly poisonous substances are produced. In this con- 
nection Burri and Dueggeli (27) have recently had occasion to exam- 
ine four samples of milk in which such alterations had occurred. 
According to these authors sample (1) had the peculiarly disagree- 
able odor of Limburger cheese, sample (2) the odor of dogs, sample 
(3) a bitter taste, and sample (4) the odor and taste of Schabzieger 
cheese. These peculiar odors and tastes were found to be due to 
specific bacteria, which were isolated and their morphological char- 
acteristics determined by these authors. 

Blue milk. — Under certain conditions a blue pigment may develop 
in milk as a result of peculiar changes set up by certain micro-organ- 
isms. While such milk is apparently harmless, it results from outside 
contamination and rarely if ever occurs in well-kept dairies. In one 
instance its production has been traced to some source of filth or un- 
cleanliness and in some instances to a single cow. Its occurrence may 
be prevented by the adoption of cleanly methods and in case it has 
been traced to any particular cow by washing the cow's teats with a 
little weak acetic acid. It is of interest to note that blue milk is the 
first dairy infection definitely traced to bacteria. As early as 1841 
Fuchs (28) traced the production of blue milk to the growth of a 
micro-organism. By using Koch's gelatin method Hueppe and Eng- 
ling (29) succeeded in isolating the organism which produces blue 
milk. It was found by these authors to produce different colors when 
grown on different media, but in solutions containing ammonium 
lactate it was always found to produce a sky-blue color. Milk in- 
fected with this organism was always found to be alkaline, but the 
blue color only appears when the milk turns sour, as the result of 
lactic-acid fermentation, or when acid is added to the milk. J. Reiset 
(30) observed that in dairies of some- localities a blue mold forms on 
the surface of cow's milk which has been allowed to stand. It has 
also been observed on the milk of ewes and goats. This mold was 
found to consist of mycelia containing immobile bacteria. The mold 
was found to grow only on milk having a distinctly acid reaction. 



369 

The chemical nature of the blue pigment was not determined. The 
organism ordinarily responsible for the production of blue milk is 
known as Bacillus cyano genes. When grown in fresh milk the effect 
produced by this organism is very striking. During the first few 
hours however no change is noticeable. A certain amount of lactic 
acid seems to be necessary for the formation of the blue substance 
resulting from the growth of this organism. As the milk turns sour 
therefore blue patches appear, until finally these may be distributed 
throughout the whole of the milk, in such cases imparting to it a sky- 
blue color. Still other organisms besides B. cyano genes seem to have 
the power of producing blue substances in milk. 

Red milk. — According to Conn (31), red milk is by no means un- 
common in the dairy. Ordinarily, however, the red color of such 
milk does not result from the growth of bacteria, but is due to the 
presence of blood in the milk resulting from injuries to the udder. 
Sometimes it results from the feeding of the cow on plants containing 
red pigment, such as the madder plant, etc.; more rarely from a 
peculiar fermentation induced by bacteria. Among the organisms 
known to produce this change in milk may be mentioned Bacillus 
erythrogenes, B. prodigiosus, and a sarcina. The production of red 
milk through the agency of bacteria is without practical significance. 

Other color changes in milk. — Still other changes have been found 
to occur in milk and practically all of the pigment- forming bacteria 
will develop their characteristic pigments in milk in the event that 
they gain access thereto. According to Conn (31) orange-colored 
milk, green milk, yellow milk, amber- colored milk, indigo milk, 
chocolate-colored milk, and black milk have all been described by 
bacteriologists. In all cases the pigment has been found to have 
been produced by bacteria. These have been isolated and their mor- 
phological characteristics determined. Ordinarily they are not nor- 
mal infections, and hence are of no practical importance in dairying. 

Slimy or ropy milk. — Under certain conditions, slimy, mucilagin- 
ous substances are produced in milk through the growth of certain 
organisms which impart to the milk a characteristic sliminess or 
ropiness. Milk possessing such properties is known as slimy or ropy 
milk. It often can be drawn out into long threads of exceeding 
fineness. For example, slimy milk has been obtained of such vis- 
cosity that it could be drawn out into threads 10 feet in length and 
of such fineness as to be scarcely visible. In certain countries slimy 
milk is esteemed a delicacy, and special methods have been de- 
vised for its preparation. Such is the case in Norway, where it is 
called by the natives " taetamoelk." In Holland also a special fer- 

45276°— Bull. 56—12 24 



370 

ment is employed in the manufacture of Edam cheese, which has the 
power of rendering the milk slimy. The cheese made from such 
milk is said to ripen more rapidly and more evenly than cheese made 
without the use of this particular organism. This peculiar change 
in the consistency of milk has also been found to be due to bacteria 
and ordinarily, as it occasionally occurs in the dairy, is a source of 
great trouble and annoyance. Many bacteria seem to have the power 
of producing a slime in milk under suitable conditions. Ordinarily, 
however, this change is accomplished by one or two bacteria having 
a wide distribution in nature. Of these B. lactis viscosus (Adametz) 
seems to be the commonest organism of the kind found in Europe, 
and a similar organism, probably the same species, occurs in this 
country. It is a very hardy organism, and finds its way into the 
milk through the water supply of the dairy. From such a source the 
infection may become widely diffused and difficult to trace. How- 
ever, it is an infection which, no matter how troublesome, can be 
eradicated through cleanliness, although in certain instances it may 
be necessary to resort to disinfectants. Among other organisms pro- 
ducing sliminess in milk may be mentioned Micrococcus freuden- 
reichii and two forms of streptococci, one the source of the slimy 
ferment in Holland, the latter present on the leaves of Pinguicula, 
the latter being employed in Norway as the source of the ferment; 
and as pointed out by Beyerinck sliminess in milk may be produced 
by certain of the lactic-acid bacteria, especially by those growing at 
low temperatures. Slimy milk also results from a diseased condition 
of the mammary gland and is a common characteristic of garget. 
Nothing is known of the chemical nature of the substances causing 
the sliminess of milk. 

Bitter milk. — Freshly drawn milk has sometimes a bitter taste; in 
other instances it acquires such a taste on standing a few hours. 
The bitter taste of freshly drawn milk is sometimes due to the passage 
of bitter substances into the milk from the food of the cow, such as 
lupines. It may also be produced during the last stages of lactation. 
In those cases in which the bitter taste develops only after standing 
the cause thereof is to be sought in changes in the composition of the 
milk due to the action of certain organisms. A considerable num- 
ber of organisms seem to possess the power of producing a bitter 
taste in milk; some of them after a short interval, others only after 
a longer one. Only the former are of any practical significance in 
the dairy, and among these may be mentioned a micrococcus, a cut 
of which is shown by Conn, and a bacillus described by Weigmann, 
both of which have the power of ruining the taste of freshly drawn 
milk in a few hours. The source of these organisms is difficult to 
trace. In one case cited by Conn the organism giving rise to this 
abnormal fermentation was traced to the milk ducts of a single cow. 



371 

According to Trillat and Sauton (32), bitter milk contains alde- 
hydes and ammonia, and results from the simultaneous inoculation 
of fresh milk with a yeast producing aldehydes, and an ammonia- 
forming bacillus, B. Fliigge, V. 

The alkaline fermentation of milk. — It has been observed that 
boiled milk never turns sour by spontaneous fermentation. On the 
other hand, when boiled milk is allowed to stand at ordinary tem- 
peratures it gradually acquires an alkaline reaction, ofttimes a bit- 
ter taste, and finally curdles, yielding a soft, slimy curd. On further 
standing this curd gradually dissolves to form a somewhat clear 
liquid, and if the fermentation be allowed to proceed for a sufficient 
length of time a semitransparent liquid is obtained, having no resem- 
blance to milk. As with the other fermentations of milk, a number 
of organisms are capable of causing the alkaline fermentation of milk, 
and a considerable number of substances are produced as the result 
of these changes. Among the substances found in milk which has 
undergone the alkaline fermentation may be mentioned the peptones, 
which are believed to be responsible for the bitter taste, leucin, tyrosin, 
and ammonia, which latter imparts to the liquid the characteristic 
alkaline reaction. Butyric acid is also formed in this fermentation. 
This, however, is at once neutralized by the ammonia present, and 
exists in the liquid in the form of ammonium butyrate. 

Alcoholic fermentation of milk. — Among the abnormal fermenta- 
tions of milk may be mentioned the alcoholic fermentation, which is 
accomplished by certain yeasts, aided in their action by certain 
species of bacteria. While the alcoholic fermentation of milk is ab- 
normal in the sense that it never occurs in milk spontaneously, but 
must be induced by direct inoculation with certain ferments, it is 
employed in the production of certain milk beverages, such as kou- 
miss and kefir, etc., which in certain countries are highly esteemed as 
articles of diet, and have in recent years come into more or less gen- 
eral use as food for invalids, etc. Koumiss, originally made by the 
alcoholic fermentation of mare's milk, is now made from cow's milk 
by the addition of eane sugar and yeast. The first action of the fer- 
ments is to hydrolyze the polysaccharides (cane sugar and lactose), 
producing the simpler sugars, glucose, levulose, and galactose, all of 
which are fermentable by yeast. Two changes then occur, the alco- 
holic fermentation, resulting in the production of alcohol and carbon 
dioxide, and the ordinary lactic acid fermentation, resulting in the 
production of lactic acid. Kefir, a similar beverage, originating in 
the Caucasus, is also made from milk by an alcoholic fermentation. 
The fermentation is carried out in leather bottles, and is started by 
means of " kefir grains," concerning whose origin but little is known. 
During the fermentation thus induced a considerable quantity of the 
ferment is produced, which is removed and dried in the sun, and thus 



372 

new supplies of the kefir grains obtained. Struve (33) gives the fol- 
lowing proximate chemical analysis of kefir grains dried at 100° C. : 

Per cent. 

Water 11. 21 

Fat 3.99 

Soluble peptone-like substances 10. 98 

Proteids soluble in ammonia : 10. 32 

Proteids soluble in caustic potash 30. 39 

Insoluble residue 33. 11 



100. 00 
The whole of the active matter of the ferment was contained in 
the insoluble residue. A microscopic examination of this showed it 
to consist of a mixture of yeast cells with Bacterium dispora Gau- 
casica (Kern). In a few specimens leptothrix and oidium lactis were 
also present. According to this author, the yeast cells, which have 
been somewhat modified by their growth in leather bottles, are alone 
responsible for the peculiar kefir fermentation. 

According to Vieth (34) milk sugar ordinarily does not readily 
undergo alcoholic fermentation with yeast. With kefir grains, how- 
ever, a rapid alcoholic and lactic fermentation takes place. Accord- 
ing to this author also the ferment of the grains consists of the 
Bacillus dispora Caucasica (Kern) and a modified form of the ordi- 
nary yeast, Saccharomyces cerevisim. According to von Freudenreich 
(35) the grains contain at least two species of bacteria and one species 
of yeast, which acting together produce the kefir fermentation. The 
bacteria effect the inversion of the milk sugar, after which a portion 
of the simpler sugar is converted into alcohol by the action of the 
yeast and another portion into lactic acid by the further action of the 
bacteria. The milk is curdled during this fermentation. 

According to Martinand (36) milk undergoes alcoholic fermenta- 
tion with a great many species of yeasts, especially if glucose and 
maltose be added, and coagulation of the milk occurs under these 
conditions even in the absence of acid. 

Part II. — (4b) Milk Poisoning — Galactotoxismus. 

Of all foods milk is probably the most subject- to contamination 
and change. Of the various forms of contamination to which it is 
liable the commonest is, as we have already seen, that which results 
from the introduction into the milk of lactic-acid-producing bac- 
teria from various sources. These organisms accomplish those 
changes which are familiar to us in the ordinary souring of milk. 
While according to Stoakley (1) buttermilk is sometimes responsi- 
ble for acute milk poisoning, it is the general opinion that sour 
milk but rarely gives rise to troubles of this character. Indeed, by 
a number of medical authorities sour milk is regarded as a very 



373 

healthful beverage, by reason of the fact that the lactic-acid-pro- 
ducing bacteria tend by their growth in the intestine to lessen intes- 
tinal putrefaction, thereby diminishing the tendency to autoin- 
toxications from substances resulting from the growth of the bac- 
terial flora normally present in the intestine. One the other hand, 
it not infrequently happens that fresh milk becomes contaminated 
with toxic substances, or with toxicogenic bacteria, in which event 
the milk may give rise to acute intoxications. The subject of milk 
poisoning has been chiefly studied by Vaughan and his associates, 
and to him we owe the term Galactotoxismus. In spite of all that 
has been done, however, the subject of milk poisoning is as yet but 
very imperfectly understood. Chiefly through the labors of Vaughan 
(2) and his coworkers, together with observations by Sonnenberger 
(3), Le Blanc (4), Baird (5), and others, it is now known that milk 
may acquire poisonous properties and become dangerous to health 
in essentially five distinct ways: 

First. It may absorb metallic poisons from metallic vessels in 
which it has been allowed to stand. Attention has already been 
called to the fact that Golding and Feilmann (6) found copper in 
milk which had stood in contact with a broken copper coil. In this 
connection Baird (5) attributed an outbreak of milk poisoning to 
the preservation of milk in metal vessels, and pointed out that the 
substitution of earthenware vessels brought about a cessation of the 
trouble. Sonnenberger (3) has also observed that milk allowed to 
sour in vessels of copper, zinc, etc., is apt to contain soluble, poisonous 
salts of these metals. 

Second. Through the elimination of poisonous drugs from the 
mother through the milk. As Sonnenberger (3) has pointed out, 
many drugs administered by the mouth appear in large quantity in 
the milk. Among such he cites ether, arsenic, alcohol, lead, col- 
chicum, euphorbin, iodine, morphine, salicylic acid, hemlock, mercury, 
turpentine, antimony, veratrine, and a great variety of salts. He 
calls attention to the fact that all such milks are dangerous to children 
and young animals, and recommends that milk from cows receiving 
active drugs should not be allowed to be sold. 

The excretion of drugs in the milk of nursing women has recently 
been made the subject of an exhaustive investigation by Bucura (7). 
According to this author, the number of drugs which have been found 
in human milk with certainty, following their administration to the 
mother, are very few. He himself investigated the excretion of 
forty of the drugs most commonly used on women during and after 
childbirth, and of these he found that only five or six could be recog- 
nized in the milk with certainty. These were aspirin, iodine, calomel 
(when taken internally), arsenious acid, potassium bromide, and 
probably also urotropin. From his own work and that of others, he 



374 

gives the following list of drugs as having been found with certainty 
after their administration to the nursing mother : Iodine ( following 
the external application of tincture of iodine or iodoform and the 
internal administration of iodides and iodothyrine) , salicylic acid 
and salicylates, ether, mercury (following the use of mercury sup- 
positories or after the interal administration of calomel) , antipyrine, 
aspirin, arsenic, and bromides. A complete bibliography of the sub- 
ject of the excretion of drugs in milk is given at the end of Bucura's 
article. 

More recently Van Itallie (23) has found that after the injection 
of pilocarpine, physostigmine, morphine, arsenious acid, fluorescein, 
phenolphthalein and other drugs, tests for their presence in the milk 
were negative, while a trace of arsenic was found following the 
administration of Fowler's solution. Reijst-Scheffer (24) fed sodium 
iodide in solution to cows and determined the amount of iodine in 
the milk colorimetrically, with the following results: Iodine in the 
whole milk, 0.00178 to 0.00372 per cent; in the casein, 0.00012 to 
0.00008 per cent; in the urine, 0.03 to 0.08 per cent. The milk fat 
contained no iodine. 

Third. Through the elimination in the milk of poisonous sub- 
stances contained in the food of cattle, especially the vegetable 
poisons of certain weeds which compose part of the diet of milch 
cows in many localities. According to Sonnenberger (ibid.) dele- 
terious cattle feed is very common. Clover fields around Worms 
(Germany), for example, have been found to contain 30 to 40 species 
of more or less poisonous plants, 15 of which are very poisonous. 
According to this author, these poisons pass into the milk if such 
plants are eaten by the cows; and these poisonous substances are 
not destroyed by boiling the milk. He found in harmony with these 
ideas that the season for infantile diarrheas around Worms corre- 
sponds not with the hot season, but with the season most favorable 
to the growth of weeds, viz, a cold, wet summer. According to 
Sonnenberger, the feeding of milch cows with vegetable refuse, such 
as potato tops, rotten apples, moldy hay, etc., tends also to poison 
the milk. 

Fourth. It has been demonstrated that milk may acquire toxic 
properties as a result of a diseased condition of the mother. Accord- 
ing to Michelazzi (See Le Blanc (4) ), the milk of a tuberculous 
animal contains a tuberculous poison, which is not entirely destroyed 
by heating to 100° C, and that the milk of such animal, when steri- 
lized at 100° C, causes a slow, chronic intoxication, and that the 
milk of a tuberculous mother is toxic to the children. Le Blanc has 
pointed out that the milk of cows in heat (les v aches taurelieres) 
has a strong, cheesy smell, and a salty, bitter taste. It alters rapidly 
even when kept in sterile tubes, and causes gastro-intestinal disturb- 



375 

ances in young animals. The toxic effect of the milk and milk prod- 
ucts of " nymphomanous " cows is even more marked. 

Lawrence (reference 79, Part I) has also recently observed the 
passage of typhoid bacilli into the milk of a nursing woman ill with 
typhoid fever. 

Fifth. As shown by Yaughan and others (2), highly toxic sub- 
stances are produced in milk by bacteria. The earlier investigations 
on the subject of bacterial poisons in milk and milk products were 
confined almost entirely to poisonous cheese, the poisonous properties 
of which were formerly ascribed to various fatty acids. In 1852, 
however, Schlossberger (see Yaughan & Novy, ibid.), from experi- 
ments with pure fatty acids, demonstrated that these substances are 
not sufficiently toxic to account for the highly toxic nature of poison- 
ous cheese. In 1883 and 1884 an epidemic of cheese poisoning 
occurred in Michigan, which led Yaughan and his students to an 
exhaustive investigation of the subject. The outcome of these studies 
was the isolation from poisonous cheese, in 1884, of a crystalline 
substance, to which Yaughan gave the name of tyrotoxicon, and 
which was believed by him to be a diazo derivative of benzene. 
Chemically it was found to be very unstable, its aqueous solution 
decomposing when heated to 90° C. Tyrotoxicon has since been 
isolated, in many instances, from poisonous cheese by other investi- 
gators. It has also been detected in poisonous milk. In 1886 New- 
ton and Wallace (8) found the poison in a milk supply at Long 
Branch which had seriously affected a number of persons. In 1887 
Firth (9), an English army surgeon, isolated it from the milk which 
had poisoned the soldiers of a garrison in India where he was sta- 
tioned, and in the same year Yaughan (10) investigated a number 
of cases of violent milk poisoning occurring at Milan, three of which 
had resulted fatally. Fresh milk, inoculated with the vomit, stomach 
contents, or an aqueous extract of the intestines, gave, after standing 
twenty-four hours at 25°-30° C, a sufficient amount of tyrotoxicon 
to enable these investigators to recognize nitrogen and phenol among 
the products of its decomposition, the latter being recognized by 
precipitation with bromine water and by other well-known tests. In 
these cases the coroner's jury, before whom this evidence was submitted, 
rendered a verdict of death from poisoning by tyrotoxicon. Camman 
(11) reported 23 cases of milk poisoning attributed to tyrotoxicon, 
and Kinnicutt (12) isolated the poison from milk which had stood 
in unclean vessels for some time. Yaughan and Novy (13) and 
others found tyrotoxicon in poisonous ice cream, and still others have 
obtained it from custards and other desserts prepared from milk 
or cream. Indeed it would appear from these investigations that 
any foodstuff prepared from milk is liable to contain this poison. 
In his later writings on the subject, however, Yaughan (14) takes 



376 

the view that tyrotoxicon is not the only poison in poisonous cheese 
and milk products. According to this author it is probably not pres- 
ent in all specimens of poisonous cheese, and it is probably not the 
most important poison of poisonous cheese. Others are also of this 
opinion. For example, Dokkum (15) by the methods used by 
Vaughan in the isolation of tyrotoxicon obtained from poisonous 
cheese a substance similar to curare in its action, five milligrammes 
of which killed frogs in thirty minutes. For this poison this author 
proposed the name tyrotoxin to distinguish it from tyrotoxicon. 
Nothing is known regarding its chemical composition. Lepierre (16) 
isolated a base having the composition C 16 H 2 gN 2 4 from poisonous 
cheese, which caused diarrhea in animals when administered by the 
mouth. During the course of their own investigations, Vaughan 
and Novy (IT) were unable to detect tyrotoxicon in certain samples 
of cheese known to have produced poisoning. From some of these 
samples they obtained a poisonous albumin. It gave the biuret test. 
It was found not to be a globulin nor a peptone. On the other hand, 
certain bacteria obtained from poisonous milk and cheese developed 
on culture media poisons which, according to Vaughan, are probably 
related to neurin. 

It has also been shown that milk and milk products may also con- 
tain a large number of bacteria each of which produces its peculiar 
toxin (18). This, according to Novy (19), is especially the case with 
the Enteritidis group of bacteria, which by their growth do not 
curdle the milk, but render it somewhat transparent. According to 
Vaughan, the summer diarrheas of children are not due in all cases 
to a specific micro-organism, but to the poisons elaborated in milk 
by many different bacteria. Such diseases are found almost exclu- 
sively among children that are artificially fed, and they occur chiefly 
in the hot weather, for the reason that a high temperature is essential 
to the growth and wide distribution of these toxicogenic organisms. 
To Fluegge (20) we are indebted for some of the most valuable con- 
tributions to our knowledge of the toxicogenic bacteria of milk, 
especially the peptonizing bacteria. By this author 12 such species 
were isolated and studied. Of these, 3 species were found to develop 
poisonous substances. Cultures of No. 1 in subcutaneous doses of 
0.5 cubic centimeter were found to kill mice. When milk containing 
this organism was fed to dogs similar disturbances set in in about 
one hour. Milk cultures of bacillus No. 3 produced diarrhea in 
puppies, followed in one case by death on the third day. The fil- 
tered culture of bacillus No. 7, after concentration to one-fifth of its 
original volume, caused death in mice and guinea pigs in six to twelve 
hours, and even the unconcentrated milk culture of this organism 
acted powerfully when fed to puppies. In market milk Fluegge fre- 
quently found these poisonous peptonizing bacteria in practically 



377 

pure culture. The investigation of the peptonizing bacteria of milk 
has been continued by Luebbert and also by Vaughan. According 
to Luebbert (21), these organisms are widely distributed. They 
have been found to act only on the proteids of the milk, the fat and 
milk sugar contained in the milk remaining undiminished. He also 
found the milk cultures of these organisms to be highly toxic. When 
fed on such milk, guinea pigs died after four days, and puppies after 
the fourth, fifth, and sixth day, following severe diarrheas. On the 
other hand, a full-grown dog ate of the milk freely without any bad 
effect, thus showing that age affords some protection against milk 
poisoning. Luebbert's results on the toxicogenic peptonizing bac- 
teria of milk have been confirmed by Vaughan (22). According to 
this author the organisms responsible for cholera infantum are truly 
pathogenic in that they produce a definite chemical poison, the ab- 
sorption of which is followed by the symptoms of the disease, and 
in order to explain the great susceptibility of infants to milk poison- 
ing and the comparative immunity of the adult he has advanced the 
view that the great susceptibility of children to such intoxications 
is due to the ease and readiness with which casein is absorbed by 
the mucous membrane of the intestine of children, and that the 
casein carries along with it the bacterial cells containing this poison. 
In the adult, on the other hand, the digestive powers of the stomach 
are increased and intestinal absorption modified to a corresponding 
degree. At present practically nothing is known regarding the pre- 
cise chemical nature of these bacterial poisons, and, as already pointed 
out by Novy (19), investigations pertaining to a more exact study of 
the toxicogenic micro-organisms of milk and their poisonous products 
belong to the future of medical and chemical research. I have been 
informed by Doctor Vaughan that nothing of any practical impor- 
tance has been added to our knowledge of the milk poisons during 
the last few years. 

PABT III.— CHEMICAL STANDARDS FOR THE CONTROL OF THE 

SALE OF MILK. 

For a number of years the sale of milk in various cities throughout 
the world has been regulated by law and various chemical standards 
regulating the sale of milk have been proposed, based on the results 
of large numbers of analyses of milk in various countries. I am 
indebted to L. A. Kogers, Acting Chief of the Dairy Division, Bureau 
of Animal Industry, U. S. Department of Agriculture, for the fol- 
lowing compilation of United States and State standards for milk 
and dairy products. It will be observed that this compilation was 
published in 1905. 



378 

[U. S. Department of Agriculture, Bureau of Animal Industry — Circular No. 74. D. E. 
Salmon, D. V. M., Chief of Bureau.] 

Washington, D. C, April 1, 1905, 
In the table following, prepared under the supervision of Ed. H. Webster, 
Chief of the Dairy Division, are given the standards for dairy products as pro- 
claimed by the Secretary of Agriculture and as established by law in the 
several States, so far as obtainable, and revised to date. 

The percentages stated represent miniumum standards in all cases unless 
otherwise expressed. States not named are understood to have no laws pre- 
scribing standards for dairy products. 

D. E. Salmon, 
Approved : Chief of Bureau of Animal Industry, 

James Wilson, 

Secretary of Agriculture. 

United States and State standards for dairy products, 1905. 



States. 


Milk. 


Skim 
milk. 


Cream. 


Butter. 


Cheese. 


Total 
solids. 


Solids, 
not fat. 


Fat. 


Total 
solids. 


Fat. 


Fat. 


Fat. 


United States ab 


Per cent. 
12 


Per et. 

8.5 


Per ct. 
3.25 


Per ct. 
9.25 


Per ct. 
18 

( c ) 


Per cent. 
82.5 


Full cream, 50 p. c. of the 

total solids to be fat. 
Full cream, 30 p. c. fat; 

half skim, 15 p. c; 

skim from skim milk. 

Fancy excepted. 
Full cream, 35 p. c. total 

solids to be fat; skim, 

fat less than 35 p. c. of 

total solids. 














Dist. of Columbia 




9 

8.5 
8 


3.5 

3.5 
2.5 
3 

3 
3 


9.3 


20 


83 

Not over 

12 p. c. 

water or 

5 p. c. salt 










11.5 










Idaho 




18 
el5 


82.5 

80 

80 
Maxi- 
mum 
water, 
15 p. c; 
salt,6p.c. 


Full cream, 30 p. c. fat 
(fancy excepted; skim, 
less than 30 p. c. fat; 
less than 15 p. c, sale 
prohibited. 

Whole milk, 48 p. c. total 
solids to be fat. 

Skirn, Tnim'mnTn fat 10 








Indiana 




9 












p. C. 



a See proclamation of the Secretary of Agriculture, " Standards of Purity of Food 
Products," Office of the Secretary, Circular No. 10, November 20, 1903. 

b Condensed milk, 28 per cent milk solids, of which one-fourth must be fat. 

c Cream containing thickener must be labeled. 

a Condensed milk must contain not less than 8.5 per cent fat ; evaporated cream con- 
taining less than 15 per cent fat must be labeled "An unsweetened condensed milk." 

e Coffee cream shall contain at least 15 per cent fat, and whipping cream at least 22 
per cent fat. 



379 



United States and State standards for dairy products, 1905 — Continued. 



States. 


Milk. 


Skim 
milk. 


Cream. 


Butter. 


Cheese. 


Total 
solids. 


Solids, 
not fat. 


Fat. 


Total 
solids. 


Fat. 


Fat. 


Fat. 




Per cent. 

12.5 

12 

12 

12.5 

13 

12 

12.5 
Sp. grav. 
1.029-33 

13 


Per ct. 

9.3 
9 


Per ct. 
3 
3 
3 

3.5 
3.7 
3 
3 


Per ct. 


Per ct. 
15 
15 


Per cent. 








80 


Skim, lessthanlOp. c. fat. 


















9.3 








April-September 


















Sp. grav. 
1.032-37 












3.5 


&20 


Maxi- 
mum 
water, 
16 p. c. 


Full cream, 45 p. c. total 
solids to be fat; skim, 
fat less than 45 p. c. of 
total solids. 

Full cream, from 3 p. c. 
milk fat; skim, from 
milk less than3 p.c.f at. 








11.5 




3 
3 

3.5 
3 




15 
15 












April-September 


13 

12 
12 
12 
12 

12 
12 
11.5 

12 
12 


9.5 


9 






















8.5 
9 


3 
3.25 

3 
3 

3 
3 










North Carolina d 




18 
15 


82.5 


Full cream, 50 p. c. total 
solids to be fat; skim, 
from skim milk; cream 
cheese, milk6p. c. min- 
imum fat. 


North Dakota 




Ohiod 




80 

Not over 
14 p. c. 
water. 


Full cream, 30 p. c. fat; 
skim, less than 30 p. c. 
fat. 

Full cream, 30 p. c. fat; 
half skim, 15 to 30 p. c. ; 
quarter skim, 7£ to 15 
p. c. ; skim, less than 7£ 
p. c. Fancy excepted. 

Full cream, 32 p. c. fat; 
three-fourths cream, 24 
p. c. fat; one-half 
cream, 16 p. c. fat; one- 
fourth cream, 8 p. c 
fat; skim, below 8 p. c. 
fat. Fancy, less than 
5 pounds, excepted. 


May-June 


9 
Sp. grav. 
1.038 

8 


20 


Oregon 


Pennsylvania 









a Condensed milk must contain the equivalent of 12.5 per cent of milk solids in crude 
milk of which 3.5 per cent shall be fats. 

6 No thickener allowed. 

c In New York, Ohio, and Wyoming the milk solids of condensed milk must be in quan- 
tity the equivalent of 12 per cent of milk solids in crude milk, of which solids 2.5 per cent 
shall be fat. 

d Condensed milk must contain 28 per cent milk solids and 7 per cent fat. 



380 



United States and State standards for dairy products, 1905 — Continued. 



States. 


Milk. 


Skim 
milk. 


Cream. 


Butter. 


Cheese. 


Total 
solids. 


Solids, 
not fat. 


Fat. 


Total 
solids. 


Fat. 


Fat. 


Fat. 




Per cent 
12 

12 


Per ct . 
8.5 
9.25 


Per ct. 
3 

2.5 

3 

3 

3 


Per ct. 


Per ct. 


Per cent. 
80 
Maxi- 
mum 
water, 16 
p. c; salt, 
6 p. c. 


Full cream, 30 p. c. fat; 
one-half skim, 15 p. c. 
fat; skim, 10 p. c. 


















South Dakota 


13 

12.5 

12.5 
12 




18 
20 


82.5 
83 


Full cream, 50 p. c. of the 
total solids to be fat; 
skim, fat less than 50 
p. c. 

Skim, 7 to 11 inches in 


Utah 


9 p. c. 

solids, 
not fat. 


Vermont 


diameter; minimum 
height, 9 inches. 


May and June 












Washington 


8 


3 

3 

2.4 




18 




Full cream, 30 p. c. fat; 

skim, 15 p. c. fat. 

Fancy excepted. 
Skim, 10 inches in diam- 


Wisconsin 








Wyoming a 


12 
11.5 








80 


eter, 9 inches height. 
Skim, lessthan20p.c. fat. 


May and June 





















a Condensed milk must contain 28 per cent milk solids and 7 per cent fat. 

At the Eleventh Annual Convention of the Association of State 
and National Food and Dairy Departments, held at Jamestown, July 
15-19, 1907, Mr. P. M. Harwood (1), general agent Massachusetts 
dairy bureau, read a paper entitled " Has the milk standard outlived 
its usefulness? " He called attention to the fact that on account of 
the rigid requirements regarding the composition of milk offered for 
sale in the State of Massachusetts a good many milk producers are 
being gradually driven from the business for the reason that while 
milk prices are gradually becoming higher in the cities, the farmer or 
milk producer does not receive a proportionate amount of the profit 
accruing from the increased price nor an amount sufficient to com- 
pensate him for the trouble and expense growing out of the enforce- 
ment of laws regulating the milk standard. He points out that at a 
recent discussion of the question of the milk standard before the com- 
mittee on agriculture of the Massachusetts legislature many interest- 
ing facts were brought out. It developed at these hearings that the 
standards now in force — viz, 13 per cent total solids, 3.7 per cent fat, 
and 9.3 per cent solids not fat, in winter, and 12 per cent total solids, 



381 

3 per cent fat, and 9 per cent solids not fat, in summer — are working 
a hardship on the farmers, and that indirectly they are not protecting 
the consumer ; that milk contractors and peddlers were using it to their 
pecuniary advantage, and that the prosecuting officers throughout 
the State were not rigidly enforcing the law. The author reached 
the conclusion, therefore, that either the milk standard should be 
abolished altogether and milk sold upon its merits, or, that if a 
standard is to be maintained, it should be uniform throughout the 
United States. On account of the very large amount of data on the 
chemical composition of milk at present available in State and munic- 
ipal departments and agricultural experiment stations, etc., such a 
standard could probably be equitably adjusted. Indeed, the attempt 
has been made to do so in establishing the United States milk stand- 
ard governing the sale of milk under the laws governing interstate 
commerce. This standard requires a milk to contain 3.25 per cent of 
fat and 8.5 per cent solids not fat, and, as may be seen from the tables 
of State and national milk standards given on page 378, it is lower 
than many of the State standards. According to the secretary of the 
association of State and national food and dairy departments, the 
United States standard is being made the basis of standards for all 
the States. 

In this connection it is of interest to note that certain high-class 
dairies throughout the country are prepared to furnish milk of any 
composition desired, and infants' milk according to the physician's 
prescription. 

PART IV.— ADULTERATIONS OF MILK. 

Like many other foodstuffs, milk is subject to many adulterations. 
These consist (1) in the removal of the cream (skimming) or the ad- 
dition of skim milk, (2) addition of water (watering), (3) addition 
of thickening agents, (4) the addition of coloring matters, (5) the 
addition of certain substances with the view of altering the taste 
of milk and increasing the total solids, (6) the addition of preserva- 
tives (antiseptics). The commonest forms of adulteration are skim- 
ming, watering, and the addition of artificial coloring matters and 
preservatives, the addition of thickening agents, such as chalk, 
calves' brains, starch, glycerin, etc., haA^ing almost passed out of 
vogue among farmers and dairymen. Indeed it is doubtful whether 
this (3) form of adulteration was ever practiced to any considerable 
extent (see Leach, 1). 

Shimming. — This form of milk adulteration is probably practiced 
among farmers and dairymen to a considerable extent. As its name 
indicates, it consists in the removal, by means of a separator or 
otherwise, of a part of the cream. Obviously, skimmed milk con- 
tains a smaller percentage of milk fat than normal milk, and it was 



382 

with a view of correcting and controlling this particular form of 
adulteration and watering that laws have been enacted in many 
countries and in many States throughout our own country fixing the 
amount of milk fat which a milk offered for sale should contain. 
It will be seen from the compilation of milk standards given on 
page 378 that the amount of fat required in different States varies 
from 2.4 to 3.5 per cent. All things considered, it seems reasonable 
to require that all milk offered for sale should contain at least 3.25 
per cent of fat, although it should be borne in mind, of course, that 
unadulterated milk, especially of certain breeds of cattle, sometimes 
contains less than this amount of milk fat. The color of skimmed 
milk is also more or less characteristic, tending more to dead white 
or bluish white than normal milk, which is distinctly yellowish white 
in color. 

Watering. — The addition of water to milk is probably the com- 
monest practice in milk adulteration. Obviously, this is done in 
order to increase the output of the dairy. The effect of watering is 
to alter the physical properties and chemical composition to a greater 
or less degree, depending on the quantity of water added. The addi- 
tion of water to milk has been found to lower the specific gravity 
and raise the freezing point of milk. It also lowers the index of 
refraction and probably the viscosity. It causes a diminution in the 
amount of fat, total solids, and ash. Ordinarily it is not a difficult 
matter to determine whether a given sample of milk has been watered. 
This is done by comparing its specific gravity and refractometer 
reading, together with the amounts of fat, total solids, and ash, with 
those of normal milk or with standards which have been based upon 
the results of thousands of analyses and years of experience with 
the milk of different herds of dairy cows and that produced in differ- 
ent countries. In the detection of watered milk advantage is also 
taken of the fact that natural waters frequently contain substances 
not ordinarily present in milk, such as nitrates and nitrites. If these 
substances are found in a sample of milk the chances are that water 
has been added to it. It has been proposed by Steinegger (2) to 
employ the aldehyde value as a means of detecting the addition of 
water to milk. The aldehyde value for normal milk in Soxhlet- 
Henkel degrees varies between 5.8° and 8.5° and is lowered by the 
addition of water to milk, but not by the removal of fats. According 
to Commanducci (3) the watering and skimming of milk may be 
determined by the lowering of what he proposes to call the index 
of oxidation of milk. This he determines by means of tenth-normal 
potassium permanganate in acid solution. The number of cubic 
centimeters of potassium permanganate solution required to oxidize 
1 cubic centimeter of milk is what this author calls the index of 
oxidation. This has been found to be different for the milk of differ- 



Ass 55-58 

Woman - 53-60 



383 

ent animals, but practically constant for the normal milk of any 
particular animal species. He gives the following values for the 
index of oxidation of the milk of the following animals : 

Cow 50-52 

Goat 44-46 

Sheep 43^8 

He also finds that the value of the index of oxidation of cow's 
milk diminishes with the amount of water added, and also with 
skimming. Thus the index of oxidation of cow's milk containing 50 
per cent of water was found to be 25, and that of skimmed milk 40 
to 42. 

According to Atkins (4), determinations of the freezing point and 
of the specific gravity of milk are sufficient to show whether water 
has been added or fat removed. 

The addition of water to milk is not only a fraudulent practice 
and one which as such should be condemned, but it may frequently 
be a serious menace to the public health. Atlee (5) has pointed out 
that impure water is one of the most frequent sources of milk pollu- 
tion. This pollution may occur either through the use of impure 
water for purposes of adulteration or as the result of washing the 
milk containers and utensils in polluted water. As is well known, 
milk is one of the best possible culture media for the growth of micro- 
organisms, especially for many of the pathogenic bacteria. It is 
conceivable, therefore, indeed it is a well-known fact, that the intro- 
duction of a few pathogenic organisms into milk through the addi- 
tion of impure water will under certain conditions give rise to a 
fluid containing countless numbers of such organisms. In this way 
the adulteration of milk with water may give rise to a widespread 
dissemination of various infections, especially typhoid fever, diph- 
theria, scarlet fever, etc. Aside therefore from the fraudulent aspect 
of the practice, the adulteration of milk with water, from any and 
every source, as frequently happens, becomes a matter of serious con- 
cern, and of all fraudulent and uncleanly practices resorted to in the 
handling and sale of milk this and the uncleanly methods of handling 
milk are the two which should be most vigorously combated and 
condemned. 

'Thickening agents. — As indicated above, the adulteration of milk 
through the use of thickening agents, such as chalk, calves' brains, 
glycerin, etc., has largely passed out of vog;ue. Indeed it is doubtful 
whether any of these substances were ever used to any considerable 
extent, despite traditions to the contrary. According to Van Slyke 
(6) gelatin and sucrate of lime are used to some extent to give a 
greater consistency to cream. In this connection Babcock and 
Russell have recommended the use of sucrate of lime for restoring 
the consistency of pasteurized cream. (See Leach (1), p. 156.) 



384 

Condensed unsweetened skim milk has also been employed as an adul- 
terant, with the object of increasing the consistency and raising the 
total solids of a skimmed or watered milk. 

The addition of substances with the view of altering or disguising 
the taste of milk or of increasing the total solids. — Milk is sometimes 
adulterated by the addition of certain substances intended to alter or 
disguise the taste of milk. These are sodium carbonate and bicar- 
bonate, cane sugar, and saccharine. Sodium carbonate and bicarbon- 
ate are sometimes added to sour milk with the view of neutralizing the 
lactic acid and preventing or delaying the separation of the curd. 
Cane sugar is added in order to increase the amount of total solids in 
milk impoverished by watering, and also to increase the sweet taste 
and thereby disguise any slightly sour taste which old milk may pos- 
sess. Saccharine is sometimes added to milk for the same purpose. 
It not only increases the sweet taste of milk, but probably also acts 
as a mild antiseptic. While all of these substances are probably 
harmless in the amounts in which they are employed in milk (cer- 
tainly the addition of cane sugar can ordinarily do no particular 
harm), the practice of adding these substances to milk is to be con- 
demned, mainly on the ground that they are rarely used except to 
conceal deficiencies in the quality of the milk itself, thereby enabling 
the dairyman to palm off on the consumer milk which ordinarily 
would not be found acceptable. 

Coloring matters. — Milk is sometimes adulterated by the use of 
artificial coloring matters. The principal object to be accomplished 
by the use of these colored substances is to conceal other forms of 
adulteration, such as skimming and watering, and to make the milk 
appear richer than it really is. It has been pointed out in the fore- 
going that skimming and watering cause an alteration of the color of 
milk as compared with normal milk. Generally milk that has been 
skimmed or watered is more whitish in color than milk containing 
the normal quantity of cream. In order to conceal these deficiencies 
in the color of milk so adulterated various artificial coloring matters 
are added in order to bring the milk up to the color of normal milk. 
Among the coloring matters which have been employed for this pur- 
pose are annatto, certain of the }^ellow and orange-colored azo dyes, 
caramel, etc. Generally speaking, the adulteration of milk with 
these artificial coloring matters is in itself of minor importance, in- 
asmuch as they are used in very small quantities and the coloring mat- 
ters ordinarily employed in the artificial coloring of milk have been 
found to be harmless. The fact, however, that they are employed 
mainly with a view of concealing other more dangerous adultera- 
tions, such as the addition of water to the milk, puts the addition of 
artificial coloring matters to milk in the class of dangerous adultera- 
tions. In this connection it has been pointed out by Winton (7) 



385 

that in the examination of a foodstuff for artificial colors the chemist 
ofttimes encounters the difficulty of distinguishing a harmless from 
a poisonous color. As a rule it is an easy matter to determine when 
a synthetic color is present, but very difficult ofttimes to determine 
its precise nature. Then again, as pointed out by Tolman (8), the 
coal-tar colors are frequently contaminated with powerful mineral 
poisons, such as arsenic, copper, tin, lead, and zinc, which are intro- 
duced as impurities in the process of manufacture. It has been 
established further that many of the coal-tar dyestuffs are poisonous 
and that still others not very actively poisonous are nevertheless suffi- 
ciently so to interfere with the action of the digestive ferments. 
For example, Houghton (9) found that annatto diminished the di- 
gestibility of casein and egg albumen by pepsin. For further 
information regarding the toxicity of the coal-tar dyes the following 
authorities should be consulted: T\ T eyl (10), Weber (11), Winogra- 
dow (12), Gudeman (13), Chlopin (14), and Meyer (15). 

Preservatives. — We have seen that milk is subject to many changes, 
principally those resulting from the life and growth therein of micro- 
organisms. Indeed, it is one of the most perishable of foodstuffs, and 
it is only b}^ exercising the most scrupulous cleanliness in the handling 
of it and by keeping it at low temperatures, generally below 50° F., 
that it can be preserved a sufficiently long time to be delivered to 
the consumer in a fresh condition. This has resulted in the practice 
on the part of dairymen of adding to the milk small amounts of 
various antiseptics and germicides, which are supplied to the trade 
under the general name of milk preservatives. The effect of such 
substances is to destroy or at least hinder the growth of all micro- 
organisms which the milk may contain, and thereby retard the 
souring of the milk ; and to prevent or at least delay the lactic-acid 
fermentation of milk is the principal object to be attained through 
the use of such substances. Among the various substances which 
have been employed as milk preservatives may be mentioned the 
following : 

Common salt, sodium bicarbonate, formaldehyde (solutions of 
which are supplied to the dairyman under the trade name of " Freez- 
ine"), borax and boric acid (solutions of the latter once sold under 
the name of "Aseptine"), salicylic acid, benzoic acid, hydrogen 
peroxide, certain fluorides, potassium dichromate, etc. Of these 
substances formaldehyde, boric acid and borax, and sodium bicar- 
bonate have probably been the most frequently employed as milk 
preservatives. In certain localities in Europe the addition of alkali 
chromates to milk was at one time a common practice, and Budde 
(16) has proposed a method for the sterilization of milk by the action 
of hydrogen peroxide at a moderately high temperature, viz, 52° C. 

45276°— Bull. 56—12 25 



386 

It is doubtful, however, whether the method ever found any very 
extensive application. According to Leach (IT) salicylic and benzoic 
acids are now rarely used as milk preservatives. Salicylic acid 
in quantities sufficient to preserve affects the taste of the milk. Rich- 
mond (18) found a new food preservative to consist of acid potas- 
sium fluoride, KHF 2 . 

As a general thing these substances are employed only in small 
amounts, and at present there is considerable difference of opinion 
as to what effect these various substances in the small amounts usu- 
ally present in milk and other foodstuffs exert upon the human system. 
Thus, according to Trillat (19), formaldehyde renders the casein of 
milk more or less indigestible, and a further objection to its use is 
that part of it remains unaltered in the various foodstuffs with which 
it is admixed, and being absorbed as such by the system may act 
injuriously on the digestion. On the other hand, Rideal and Foul- 
erton (20) have observed that formaldehyde at a dilution of 1: 50,000 
or 0.05 per cent of boric acid and borax will preserve milk twenty- 
four hours, and that these amounts of these substances have no 
effect on the peptic and pancreatic enzymes, while this quantity of 
boric acid greatly retards the diastatic power of saliva, the formal- 
dehyde having much less effect. Experiments with kittens, rabbits, 
and guinea pigs proved, according to these observers, that the 
amount of formaldehyde required to preserve milk has no effect on 
their proteid metabolism. Fish were not affected in six days in water 
containing 1 part of formaldehyde in 50,000 parts of water, and 
frogs stood a concentration of 1 : 20,000 without injury for two hours. 
The conclusion drawn by these writers from their investigation is 
that the quantities of these substances necessary to preserve milk 
twenty-four hours have no appreciable effect on the digestibility of 
the milk, and that in these quantities formic aldehyde and boric acid 
interfere less with the pancreatic digestion of casein than tea, claret, 
and Worcester sauce. Formaldehyde, 1 : 50,000, does not appear to 
have any injurious action upon animal tissues, or on nutrition. On 
the other hand, Otto Hehner (21) has criticized the experiments by 
Rideal and Foulerton on the ground that they were not properly con- 
trolled, and this author seems inclined to believe from the results 
obtained that these substances, in the quantities employed, were in 
reality injurious to the animal organism. T. M. Price (22), working 
in the Biochemic Division of the Bureau of Animal Industry, U. S. 
Department of Agriculture, has made a valuable contribution to this 
subject. He has studied the effect of some food preservatives on the 
action of the digestive enzymes, especially the effect of formaldehyde 
on the preservation of milk and the effect of this substance on the 
digestibility of the milk by the digestive enzymes in vitro and in the 



387 

stomach of the calf. The following are the more important conclu- 
sions which he has drawn from these investigations : 

(1) Formaldehyde in the proportion of 1:20,000 preserves the 
milk for forty-eight hours. 

(2) Formaldehyde in milk in the proportion of 1: 10,000 does not 
interfere with the digestion of the milk when it is fed to calves. 

(3) Upon feeding calves through a long period' with milk pre- 
served with formaldehyde the calves remained healthy and gained 
in weight. 

(4) Formaldehyde added to milk in the proportion of 1 : 2,500 or 
less has no effect on the activity of the fresh enzymes, rennet, pepsin, 
pancreatin, and steapsin, in vitro. 

(5) Formaldehyde added to starch in the proportion of 1 : 2,500 or 
less has no effect on the conversion of the starch into sugar by the 
enzymes ptyalin and amylopsin, in vitro. 

(6) Formaldehyde added to milk in sufficient quantity to preserve 
the milk for forty-eight hours — i. e., 1 : 20,000 — does not materially 
interfere with the action of the enzyme galactase, in vitro. 

(7) Formaldehyde added to milk in the proportion of 1:20,000 
prevents the development of the more common bacteria found in 
milk and when added in the proportion of 1 : 1,560 it kills these 
bacteria. 

(8) Formaldehyde may be added to milk in sufficient quantities 
to preserve the milk and to prevent the development of some of the 
more common bacteria — i. e., 1 : 10,000 — and still have no deleterious 
effect on the digestibility of the milk for calves. 

(9) Formaldehyde should never be fed to calves as a milk pre- 
servative stronger than 1 part of formaldehyde to 10,000 parts of 
milk. 

According to Price the results obtained by the majority of inves- 
tigators who have experimented with formaldehyde are of no value, 
inasmuch as at least the majority of them employed formaldehyde 
solutions varying in concentration from 1 : 25 to 1 : 2,000, these quan- 
tities being very much larger than the quantities of formaldehyde 
used in the preservation of milk in practice. At the close of his arti- 
cle Price gives the following bibliography of the subject : 

(1) Salkowski u. Halm, Pfluger's Archiv., Bd. LIX u. LXIII ; Moraczewski, 
Zeitschr. f. physiol. Chem., B. XX. 

(2) Babcock and Russell, Wis. Ann. Kept. Ex. Stat, Vol. XIV, 1897, p. 161. 

(3) Snyder, Minn. Ex. Stat. Bull. No. 74. 

(4) Babcock and Russell, Wis. Ann. Rept. Ex. Stat., Vol. XV, 1898, p. 17. 

(5) Van Slyke, Rept. N. Y. Ex. Stat., Vol. XX, 1901, p. 165. 

(6) Loew, Ann. Agronom., Vol, XCVIII, p. 416; Pottevin, Ann. de l'lnst. 
Pasteur, 1897, p. 807; Symons, Jour. Am. Chem. Soc, Vol. XIX, 1897, p. 724; 
Foulerton, Lancet, Vol. XI, 1899, p. 1578 ; Bliss and Novy, Jour. Ex. Med., Vol. 



388 

IV, 1899, p. 60 ; Halliburton, Brit. Med. Jour., Vol. XI, 1900, p. 1 ; Rideal and 
Foulerton, Pub. Health, 1899, p. 554. 

(7) Cripp, Analyst, Vol. XXII, 1897, p. 182; Allen, Lancet, Vol. I, 1896, p. 
1516; Ringer, Jour, of Phys., 1895, p. 425; Chittenden, Diet, and Hyg. Gaz., 
1893, p. 25 ; Mayberry and Goldsmith, Chem. Centralbl., 1898, p. 69 ; Leffmann, 
Jour. Franklin Inst., 1899, p. 103; Weber, Jour. Am. Chem. Soc, 1902, p. 4; 
Chittenden and Gies, Am. Jour. Phys., 1898, p. 1; Tunnicliffe and Rosenheim, 
Jour. Hyg., 1901, p. 168 ; Forstus, Archiv. of Hyg., Vol. XI, 1884, p. 75 ; Liebreich, 
Vierteljahrsschr. gericht. Medizin, 1900, p. 83. 

Reference has already been made to the fact that Trillat (19) found 
that formaldehyde renders the casein of milk more or less indiges- 
tible. In this same connection Pottevin (23) has observed that for- 
maldehyde retards the coagulation of milk by rennin. Further 
experiments along this line have been made by Bliss and Novy (24). 
These authors have confirmed the conclusions of Pottevin regarding 
the influence of formaldehyde on the coagulation of milk by rennin 
and have found that under the influence of formaldehyde the casein- 
ogen of milk is rapidly altered in such a way that either the rennin 
coagulation takes place only very slowly or not at all. Thus if for- 
maldehyde in the proportion of 1 : 500 be allowed to act on milk for 
a, few hours the milk is not coagulated on the addition of rennin. 
On the other hand, they observed that the rennin itself is not readily 
destroyed by formaldehyde, so that the delay or hindrance of the 
rennin coagulation of milk by formaldehyde is evidently due in some 
way to an alteration in the composition or properties of the casein- 
ogen. Similar experiments on the action of formaldehyde on the 
digestive ferments have been made by Halliburton (25) . Pie observed 
that 0.5 per cent of formaldehyde renders gastric digestion almost 
impossible, and 0.05 per cent delays it considerably. With 0.1 per 
cent formaldehyde no pancreatic digestion of fibrin occurs in twenty- 
four hours, and dilute solutions of the aldehyde delay the pancreatic 
digestion of starch. He also confirms the deleterious effects exerted 
by formaldehyde on the rennin coagulation of milk. 

Wiley and his coworkers have also studied the effect of formalde- 
hyde on the health of man. The results of this investigation, how- 
ever, have not yet been published. 

Concerning the toxic effects of boric acid and borax there is also the 
greatest difference of opinion among those who have made a study of 
the subject, and more recent investigations, despite their exhaustive 
character, have tended by no means to reconcile these opposing 
views, but if anything to accentuate them. For example, J. Neu- 
mann (26) found that only very large doses of boric acid can cause 
death by gastroenteritis or from its effects on the nervous or muscular 
systems. He therefore recommended it for the preservation of milk. 
According to Cyon (27) borax diminishes proteid metabolism, but all 
that can be learned from his work on the subject is, that metabolism 



389 

and assimilation were not seriously interfered with by borax in the 
quantities administered. Gruber (28), on the other hand, found that 
borax increases proteid metabolism and concludes that borax exerts 
no unfavorable influence on the assimilation of food. According to 
this author, no harmful effect followed a maximum dose of 20 grams. 
Forster (29), from his studies on the applicability (verwendbarkeit) 
of boric acid as a food preservative, concludes that, while boric acid is 
without influence on proteid metabolism, the continuous administra- 
tion of small amounts of it in food is not without its drawbacks so far 
as the health of the individual is concerned, and that its use as a milk 
preservative, especially in milk to be used by children, should be con- 
demned. G. T. Welch (30) records some alarming instances of poison- 
ing following the local application of large amounts of boracic acid ; 
and Chittenden (31) observed that while borax in moderate amounts 
exerts no inhibitory action on the peptic and tryptic digestion of pro- 
teids, in larger quantities it retards the proteolytic activity of both of 
these digestive fluids. Later, Chittenden and Gies (32) made an 
exhaustive study of the action of borax and boric acid on nutrition, 
with especial reference to their effect on proteid metabolism, the 
experiments being made upon full-grown dogs. They found as the 
result of these studies that small doses of boric acid, up to 3 grams per 
diem, are practically without effect upon the proteid metabolism and 
the general nutrition of the animals, and that even moderate doses of 
borax are practically without effect. Large doses of borax tend to 
retard somewhat the assimilation of proteid and fatty foods, and with 
very large doses there is a tendency to diarrhea and an increased 
excretion of mucus. Borax and boric acid in very large amounts 
(equal to 1.5 to 2 per cent of the food) are liable to produce nausea 
and vomiting. Both borax and boric acid are quickly eliminated 
from the body, almost entirely through the urine, and in none of the 
experiments were any abnormalities in the urine observed. 

Reference has already been made to the work of Rideal and Fouler- 
ton (20) on boric acid and formaldehyde as milk preservatives. In 
this connection it may be well to call attention again to their conclu- 
sions. According to these authors, (1) boric acid, 1:2,000, and 
formaldehyde, 1 : 50,000, are effective preservatives for milk for 
twenty-four hours; (2) in these quantities these substances have no 
appreciable effect on digestion or on the digestibility of foods thus 
preserved. On the other hand, according to F. J. Allen (quoted by 
Halliburton (25)), borax delays or prevents the rennin coagulation 
of milk. An excellent resume of the earlier pharmacological work 
on boric acid and borax is given by Liebreich (33). We gather from 
the data which are there presented that since its introduction into 
medicine in the seventeenth and eighteenth centuries there have been 
occasional accidents and deaths from boric- acid poisoning. In these 



390 

instances, which were comparatively rare, very large doses of boric 
acid and borax were employed, and in certain instances, at least, the 
bad results reached through the employment of these substances as 
drugs could be explained as resulting from a marked idiosyncrasy on 
the part of the patient, and in certain other instances, as pointed out 
by Liebreich, death and the bad effects following the use of these 
compounds were in all likelihood traceable to other causes. Among 
those who have observed bad effects following the administration of 
boric acid and borax may be mentioned Gowers, Evans, Molodenkow, 
Lemoine, Bruzelius, Warfwinge, Rasch, G. T. Welch, and others. 
(See Liebreich (33).) On the other hand, boric acid was early 
recognized as a mild antiseptic, and was recommended in surgery as 
a dressing for wounds by Lister, Godlee, and others. Particularly 
good results were obtained through its use by Cane, so that to-day 
the value of boric acid as a mild antiseptic wash and dressing powder 
is fully recognized and its use in these directions is extensive and far- 
reaching. It is concerning its effects on the system when taken inter- 
nally, however, that the greatest differences of opinion prevail. 
Opposed to those who have described bad effects and even death 
following the administration of boric acid and borax, we have the 
testimony of other medical authorities regarding the harmless char- 
acter of boric acid preparations. Liebreich (33) cites the cases 
described by Polli in Legendre's " Traite practique d'Antiseptique 
applique a la Therapeutique et 1'Hygiene " of a soldier who swallowed 
25 grams of boric acid without bad results. Polli cites the cases of 
eight persons who took 2 grams of boric acid in milk daily for forty- 
five days and 4 grams daily for twenty-three days without showing 
the slightest abnormal symptoms. Also the great Virchow, having 
observed his own urine to be abnormal, kept himself on an alkaline 
regimen for three months by the use of large doses of borax followed 
in the morning by Carlsbad water. The results reached are best 
given in his own words : " Ich fuhr 3 Monate lang mit meinem alka- 
lischen Regime fort, und bis auf den heutigen Tag habe ich niemals 
weder Eiter abgesondert, noch Albumen, noch Cylinder producirt; 
mein Hani ist so klar wie der einer Jungfrau." Binswanger also 
conducted a series of tests upon himself with the view of determining 
the effect of boric acid. During one day he took 18 decigrams with- 
out effect, except possibly to increase his appetite. When he took 
two doses of 3.654 grams in two hours vomiting set in, and when he 
took the third dose later in the same day he again vomited, but after 
two hours regained his normal condition. G. T. Welch quotes 
Gaucher to the effect that the fatal dose of boracic acid is 2.5 ounces, 
continued for at least ten days. On the basis of these observations 
and also certain observations on himself and from results reached in 
his study of the effects of boric acid and borax on animals, such as 



39i 

dogs, rabbits, guinea pigs, etc., Liebreich (33) enters into a somewhat 
vigorous defense of the use of boric acid and borax as food preserva- 
tives. It is his opinion that much of the opposition to the use of 
boracic preparations for such purposes grows out of prejudices 
handed down from bygone times, and he calls attention to the fact 
that in this connection undue stress has been laid upon the accidents 
resulting from the use of boric acid in surgery, and that to a consider- 
able extent the opposition to the use of boric acid and borax as food 
preservatives is founded upon conclusions drawn from imperfect 
experimental researches. To him the critical spirit of this later-day 
investigation of such subjects as food preservatives is a matter of 
regret, and in one of his communications, " Ueber Conservirung durch 
Borsaeure " (34), he inquires somewhat petulantly, "Who would 
have made the introduction of pickled meat, smoked beef, and such 
Kke dependent on a chemical or pharmacological investigation?" He 
emphasizes the fact that notwithstanding that borax and boric acid 
have been in use as food preservatives for a series of decades not a 
single case of injury to health has been observed. Lebbin (35) failed 
also to discover any harmful effect from eating meat preserved with 
boric acid, and hence points out that no objection can be urged against 
its use as a preservative. Tunnicliffe and Rosenheim (36) studied 
the influence of boric acid and borax on the general metabolism of 
three children, and arrived at the conclusion that small doses, up to 
1 gram per day, continued for some time, exert no influence on the 
proteid metabolism in healthy or delicate children. Both boric acid 
and borax were quickly eliminated from the system, and neither 
substance affected the general health or well-being of the children in 
any way. 

A second treatise by Liebreich (37) on the effect of boric acid and 
borax on the human system appeared in 1902, the object of which, 
according to the author, was to refute certain erroneous and insuffi- 
cient observations likely to encourage prejudices against the use of 
these compounds. He criticises the observations of Robinson, Kister, 
Hanford, Rose, Rost, Rubner, Mattern, Heffte, Le Bon, and others, 
on the grounds that they are based on faulty and inaccurate observa- 
tions ; that the tests and observations are not decisive, that in certain 
instances they involve contradictions; that the boric acid and borax 
were not administered with food, but were taken directly into the 
system, and that in certain instances the real cause of the disturbance 
attributed to borax and boric acid was in all probability badly pre- 
served meat ; and by way of further confuting the results reached by 
other observers regarding the toxic action of boric acid and borax he 
cites the findings of Tunnicliffe and Rosenheim, to the effect that 
children increased in weight on a diet containing borax and boracic 
acid. Liebreich is of the opinion, therefore, that practical experience 



392 

justifies the use of boric acid and borax as food preservatives. Wiley, 
Bigelow, and others (38), as the result of their study of the effect of 
boric acid and borax on man, have found that while the persons under 
experiment were in many instances made temporarily ill by the quan- 
tities of boric acid administered, at the end of the year, after the final 
after period, they appeared to be, and so expressed themselves, in 
better physical condition than when they entered on the experi- 
mental work. 

It has already been pointed out that salicylic acid and benzoic acid 
are only rarely used as milk preservatives. This is fortunate, since 
both of these substances must be looked upon as toxic, to a degree at 
least, and the former, at least, seems to be more or less cumulative 
in its toxic effects upon the system. The injurious effects resulting 
from continuous small daily doses of salicylic acid were first pointed 
out by Brouardel (39), who made a plea for its discontinuance as a 
food preservative and for more thorough and systematic examina- 
tions of preserved foodstuffs by chemists and health officers. The 
effect of salicylic acid and the salic}dates on man has also been investi- 
gated quite recently by Doctor Wiley (40) and his coworkers at the 
hygienic table. He points out in his general conclusions that there 
has been a general consensus of opinion among scientists and medical 
authorities that salicylic acid and its compounds are very harmful 
substances and that the prejudice against them is perhaps greater 
than against any other form of food preservatives. While he is still 
inclined to look upon it as a harmful substance, it is probably of less 
virulence than has heretofore been supposed. 

Attention has already been called to the use of hydrogen peroxide 
in the sterilization of milk. In its 3 per cent solution this substance 
has been employed by Budde (16) to sterilize milk at somewhat lower 
temperatures than those employed in the ordinary processes of pas- 
teurization, and attempts have also been made to remove all traces of 
the peroxide remaining in the milk after such treatment. According 
to Lakin (41), however, these attempts have not proven practicable, 
and this author therefore objects to Budde's process of sterilizing 
milk on the ground that it still contains small amounts of the un- 
changed hydrogen peroxide, and also in consequence of the injurious 
impurities which commercial solutions of hydrogen peroxide are 
liable to contain — such as boric acid and arsenic — which are present 
in the substances from which the solutions of hydrogen peroxide are 
made. He adds, however, that the consumption of milk sterilized 
by this method is not known to have produced any injurious effects. 
P. Gordan (42) has shown that the small amounts of hydrogen 
peroxide employed by Budde in his process of sterilizing milk have 
practically no sterilizing action, and that if employed in quantities 
sufficient to sterilize, it imparts a taste to the milk and renders it 



393 

unfit for human consumption. According to a number of authorities 
hydrogen peroxide is apparently harmless in its effects. Amberg 

(43) quotes the following authorities on this point: Jablin-Gonnet 

(44) fed milk containing hydrogen peroxide to young animals and 
took it himself for two months without ill effect. Eosam (45) took 
within a period of three months a quantity of hydrogen peroxide, 
in milk, corresponding to 1,800 cubic centimeters of a 3 per cent 
solution without the least injurious effect, and Vandervelde (46) 
claims to have shown that hydrogen peroxide favors the action of 
rennin, pepsin, trypsin, and galactase. 

Concerning the possibility of injurious effects resulting from the 
use of fluorides as milk preservatives, it may be said that the evidence 
now at hand goes to show that these substances are irritating poisons 
of considerable power. That such is the case may be seen from the 
following observations which have been made on their toxicity: 
Kubuteau (47) found that 0.5 gram of sodium fluoride given by 
the mouth produced sickness in dogs and 0.25 gram by mouth 
produced sickness in rabbits. When injected subcutaneously 0.25 
gram of sodium fluoride proved fatal to rabbits. Kolipinski (48), 
who successfully employed sodium fluoride in minute doses in 
epilepsy, intermittent fever, and sympathetic headache, observed that 
5 grains caused vomiting in a dog, when administered by the mouth, 
and that 3 grains injected into a dog or cat caused death in a 
few hours. The urine in such cases was found to contain small 
amounts of albumen, and to be rich in fluorine, indicating its elimi- 
nation by the kidneys. Schulz (49) found the lethal dose of sodium 
fluoride for rabbits to be 0.2 to 0.4 gram, for dogs 0.3 gram, and for 
frogs 0.005 to 0.006 gram. Heidenhain (50) found the lethal dose 
for dogs to be 0.05 to 0.1 gram per kilo body weight. Weinland (51) 
observed that a 2.1 per cent solution of sodium fluoride killed the 
mucous membrane of the throat of a frog and Gruentzner (52) found 
that at such a concentration living nerves are destroyed. Czrellitzer 
(53) found it to be an active poison for all form of cells, and for 
protoplasm generally, but states that no satisfactory explanation of 
its toxicity is yet known. Kastle and Loevenhart (54) found it 
highly toxic to lipase, the fat-splitting ferment, and quite recently 
Loevenhart and Pierce (55) have considerably extended these obser- 
vations, and have found that sodium fluoride retards the action of 
lipase when present in a solution of the ferment at the great dilution 
of one to one hundred million. 

Baldwin (56) has called attention to several cases of accidental 
poisoning by sodium fluoride, that came under his observation, in 
which an insecticide consisting of sodium fluoride was mistaken for 
baking powder and used in the making of griddlecakes. In these 
cases violent vomiting and purging followed quickly after the eating 



m 

of these cakes, which probably contained rather large amounts of the 
fluoride. These observations led the author to test the toxicity of 
sodium fluoride on himself. He found that 0.03 gram of sodium 
fluoride, eaten with bread, produced no effect. Neither did 0.09 
gram taken a little later. 0.25 gram taken on an empty stomach 
produced nausea in two minutes, which effect reached its maximum 
in twenty minutes. During this time there was an increased flow 
of saliva and retching, but no vomiting. In about two hours these 
symptoms had subsided. Luncheon was then eaten, but without 
relish. Vomiting occurred immediately after eating, and slight 
nausea continued throughout the day on which the poison was taken. 
Baldwin concludes from his observations that sodium fluoride 
belongs to the class of less violent poisons, the characteristic symp- 
toms being nausea, vomiting, and salivation. 

According to Van Slyke (57) potassium dichromate is not a very 
violent poison, though not entirely harmless. 

Concerning the physiological effects of such substances as common 
salt, sodium bicarbonate, etc., nothing need be said in this connection. 

It is evident therefore that those who have made the closest study 
of the use of preservatives in food are very much divided in their 
opinion regarding the possibility of ill effects resulting from their 
use. Indeed the whole subject of food preservatives has been dis- 
cussed from practically every standpoint, A priori, most of us would 
probably be inclined to proceed on the assumption that a substance 
which is toxic to micro-organisms is also toxic to the cells com- 
posing the tissues of man and the higher animals. In his testimony 
before the food-preservatives committee, London, Halliburton (25) 
took the stand that the use of food preservatives should be abandoned 
and methods of cold storage and transportation substituted in their 
place, upon the ground (1) that an antiseptic which is inimical to the 
life of those organisms that cause putrefaction can not be harmless 
to the vital processes of the higher animals; (2) numerous clinical 
observations have been recorded which show that dyspeptic and 
other troubles follow the use of foods which have been treated with 
preservatives ordinarily employed for such purposes, such as borax ; 
(3) even if as in the case of boric acid and borax, the poison is 
not cumulative, the continuous passage of foreign substances through 
the kidneys can not be beneficial to those organs. A similar stand 
against the use of preservatives in food has been taken by Leffmann 
(58). According to this author, the bad effects of a food preserva- 
tive may show itself in several ways: (1) It may interfere with the 
action of the digestive ferments, as has been proven in the case of 
salicylic acid; (2) it may act on the food, like formaldehyde; and (3) 
it may work a direct injury to the body as is known to be the case 
with almost all mineral preservatives. Hope (59) looks upon it as 



395 

proven beyond dispute that chemical preservatives while checking the 
putrefactive changes in food, also check the fermentative processes 
of digestion. Especially does he regard the use of preservatives in 
milk as absolutely indefensible, and points out that the experiments 
of the bacteriological department of the Thompson- Yates laborato- 
ries are sufficient in themselves to establish the dangers of this prac- 
tice, even if they stood alone. According to this author, there are 
numerous cases of injury resulting from the use of milk so preserved. 
He is therefore of the opinion that cleanliness and cold alone should 
be relied upon to insure the preservation of milk. Vaughan and 
Veenboer (60) have arrived at the conclusion that it is desirable to 
prevent the use of formaldehyde in any and all foods, and also not to 
allow the use of any preservatives in milk. They are of the opinion, 
however, that the use of one-fourth of 1 per cent of boric acid in 
cream would probably not prove harmful. The English commission 
appointed to inquire into the subject of food preservatives, upon the 
testimony and findings of seventy-eight experts, prohibited the use 
of all preservatives and coloring matters in milk, and at the Inter- 
national Congress of Hygiene, held at Brussels in 1903, resolutions 
were passed practically prohibiting the use of preservatives in all 
kinds of foods. 

On the other hand, Rideal and Foulerton (61) contend that in view 
of the exceedingly perishable nature of milk, and the fact that it fre- 
quently has to be brought long distances before reaching the con- 
sumer, the use of a preservative is not only legitimate, but distinctly 
advantageous from a hygienic standpoint, providing that the pre- 
servative is not injurious to the health of the consumer. It may be 
said finally, however, that the preponderance of medical and scientific 
opinion is decidedly against the use of preservatives in milk, not only 
on account of possible injuries, especially to young children, resulting 
from the continued use of such preservatives in small amounts, but 
also for the reason that the use of such substances, if permitted, 
would ultimately tend to carelessness and uncleanliness in the hand- 
ling of milk. Cleanliness and cold, the rigorous enforcement of the 
tuberculin test, and proper medical supervision of the dairies and 
those who handle the milk, are the prime essentials for a pure milk 
supply, and no method of sterilization or preservation is likely to 
give as good results. 

In this connection, Richmond (62) has pointed out that in hot 
summer weather milk preservatives are comparatively useless unless 
added in relatively large quantities. He also calls attention to the 
fact that when once the souring of milk containing a small amount 
of preservative begins it proceeds at an increased rate as compared 
with milk to which no preservative has been added. 



396 

An actual case of milk adulteration which came under our obser- 
vation at the Hygienic Laboratory will serve to illustrate the different 
phases of this subject. On July 23, 1907, a sample of milk was re- 
ceived from the Jamestown Exposition. According to the statement 
of the person submitting the sample, this milk was a sample of the 
milk supplied the guests at one of the tables of a hotel within the 
exposition grounds. This sample of milk gave the following num- 
bers on analysis : 

Specific gravity 1. 0213 

Fat per cent 1.7 

Total solids do 7.5 

Total solids not fat do 5.80 

Ash do . 43 

Milk sugar do 3.37 

Refractometer reading 32. 1 

It was also found to contain formaldehyde and to be artificially 
colored with an azo dye. It was also found to contain a large num- 
ber of bacteria per cubic centimeter. The results of our examination 
of this milk show that the milk was watered. The fact that it con- 
tained a large number of micro-organisms despite the addition of 
formaldehyde indicates either that proper care had not been exer- 
cised in drawing the milk from the cow or that the proper care and 
cleanliness had not been exercised in handling it, or that the attempt 
had been made to keep it for too long a time and probably at too 
high a temperature. Such milk is not only below standard so far as 
food constituents is concerned, but it is exceedingly liable to infec- 
tion, yet this was a sample of the milk probably supplied to many 
persons while they were guests at this hotel. This single instance is 
sufficient to illustrate the real significance of milk adulteration and 
its possible dangers. 

PART V.— THE WASHINGTON" MILK SUPPLY. 

So far as our experimental work on this subject is concerned, the 
principal object has been to determine the general character of the 
milk at present supplied to the consumer in Washington and the 
District of Columbia. With this in view, routine chemical analyses 
have been made of milk offered for sale by various milk dealers in 
the city of Washington and the District of Columbia, from the 5th 
of July, 1907, to the 27th of September, 1907, inclusive. So much 
has been written on the subject of the routine analysis of milk, and 
the methods at present employed are generally so well understood, 
that only a few words concerning the methods employed in this 



397 

investigation are required. For further details concerning methods 
of milk analysis, the reader is referred to the following standard 
works on this subject, viz, Modern Methods of Testing Milk and 
Milk Products, Van Slyke, New York, 1907; and Food Inspection 
and Analysis, Leach, New York, 1907. The chemical examination 
of the Washington milk supply has included the determination of 
specific gravity, total solids, fat, sugar, ash, acidity, refractometer 
reading, quantity of dirt by volume, and tests for preservatives. 
During the month of September special attention was paid to the 
examination for preservatives, and during this time the determination 
of sugar and total solids was omitted. The latter were calculated 
from the specific gravity and the percentage of fat according to Bab- 
cock's rule. The samples submitted for examination were collected 
by certain inspectors of the health office, and as soon as collected were 
put on ice and kept there until delivered at the Hygienic Laboratory, 
and until the chemical examinations were completed. As soon as 
the sample was brought into the laboratory, the acidity of the milk 
was determined on 50 cubic centimeters of the sample. The specific 
gravity and the percentage of fat and also the refractometer reading 
(the latter on the milk serum) were also determined practically as 
soon as the sample reached the laboratory, especially in those cases in 
which owing to lack of time the total solids were not determined by 
weighing, and in the event that these determinations indicated that 
any particular sample was below standard, the total solids on this 
particular sample were determined by weighing in the manner de- 
scribed in the following: 

Specific gravity. — The specific gravity of the milk was determined 
either by means of the Westphal balance or by means of the Que- 
venne lactometer. 

Total solids and ash. — The total solids and ash were determined by 
the method recommended by Leach ( 1 ) . This method consists in 
heating 5 grams of the milk on the steam bath for three hours, in 
small flat platinum dishes. At the end of this time the dishes were 
removed from the steam bath and while still hot were wiped dry 
with a piece of soft toweling. They were then allowed to cool and 
weighed. In this way we obtained the weight of the residue from 
5 grams of milk, and from this we calculated the percentage of total 
solids. The ash of the milk was then determined on the same sample 
by ignition at a low red heat, cooling and weighing the dish and its 
contents the second time. The ash left after this operation was tested 
for boric acid by the turmeric test. 



398 

Fat. — The quantity of butter fat in the milk was determined by 
the Babcock centrifugal method. This is the most rapid method 
known for the determination of fat in milk. It compares very 
favorably as to accuracy with the most exact methods now known for 
the determination of fat in milk, and it is the method ordinarily 
employed in practice for this purpose. 

Lactose. — The amount of lactose in the several samples of milk was 
determined polarimetrically after the removal of the milk proteids 
by means of an acid solution of mercuric nitrate. 

Acidity. — The acidity of the milk was determined by titrating 50 
cubic centimeters of the sample with tenth-normal sodium hydroxide, 
using phenolphthalein as the indicator. 

One cubic centimeter of tenth-normal sodium hydroxide, contain- 
ing 0.004 gram of sodium hydroxide, is equivalent to 0.009 gram of 
lactic acid. Hence each cubic centimeter of tenth-normal sodium 
hydroxide required by the 50-cubic-centimeter sample of milk is 
equivalent to 0.018 per cent of lactic acid. In order, therefore, to 
obtain the per cent of acidity of the sample we multiply the number 
of cubic centimeters of tenth-normal sodium hydroxide required for 
neutralization by 0.018. The product is the acidity of the milk in 
percentage of lactic acid. 

Thoerner (2) has suggested as a practical limit for wholesome milk 
an acidity equal to one-fifth of the volume of the milk in cubic cen- 
timeters of tenth-normal caustic soda. This would correspond to an 
acidity of 0.18 per cent of lactic acid. According to Van Slyke (3), 
the average acidity of English market milk, supposed to be 12 to 18 
hours old, is 0.18 per cent, and of German milk 0.13 to 0.18 per cent. 
According to this author, market milk should not in any case contain 
over 0.2 per cent total acidity when it reaches the consumer, and 
generally should be under 0.15 per cent. According to Tuley (4), 
the milk of swill- fed cows is hyperacid. 

Dirt. — The quantity of dirt or suspended matter in the milk may 
be estimated either gravimetrically (Renk, quoted by Ott (5)) or 
volumetrically (Van Slyke). The gravimetric method requires a 
large volume of milk and also requires considerable time. The volu- 
metric method is rapid, and only small amounts of milk are required. 
For this reason the latter method was employed. Fifteen cubic centi- 
meters of the sample was placed in a Bausch and Lomb graduated 
centrifuge tube. The samples were then centrifugalized for five 
minutes. The dirt then collects on the bottom of the tube, and the 
volume of it is read. From these readings the per cent of dirt is 
calculated. 



399 



Refractometer reading. — Milk serum has a higher index of refrac- 
tion than water. Therefore the addition of water to milk lowers the 
index of refraction of the serum The refractometer reading of the 
several samples was obtained in the following manner : One hundred 
cubic centimeters of the sample of milk is placed in a beaker. To 
this 2 cubic centimeters of 25 per cent acetic acid is added. The 
beaker is then covered with a watch glass and heated in a water bath 
at 70° C. for twenty minutes. It is then placed in ice water for ten 
minutes and filtered. The refractometer reading on the clear yellow- 
ish filtrate (milk serum) is then made with a Zeiss immersion refrac- 
tometer, at 20° C. A description of this instrument, together with all 
necessary directions for its use, is given by Leach (6). See also 
Wagner (7). Unadulterated milks give a refractometer reading 
varying between 39 and 43 on the scale of this instrument. Accord- 
ing to Leach (8), a reading below 40 with the above conditions care- 
fully observed would be suspicious of added water, though 39 might 
more safely be placed as a limit, below which milk could be declared 
fraudulently watered. 

The following data given by Leach (9) show the variations in the 
specific gravity, refractometer reading, chemical composition, etc., 
resulting from the addition to a whole milk of various amounts of 
water up to 50 per cent. 







Determinations 


on milk. 






On milk serum. 


Added 
water. 


Total 
solids. 


Water. 


Fat. 


Solids 
not fat. 


Ash. 


Specific 

gravity at 

15° C. 


Specific 

gravity at 

15° C. 


Immersion 
refrac- 
tometer 

reading at 
20° C. 


Per cent. 


Per cent 


Per cent. 


Per cent. 


Per cent. 


Per cent. 











12.65 


87.35 


4.00 


8.65 


0:65 


1.0315 


1. 0287 


42.40 


10 


11.33 


88.67 


3.50 


7.83 


.60 


1.0278 


1.0260 


39.75 


20 


10.10 


89.90 


3.10 


7.00 


.53 


1. 0252 


1.0230 


36.90 


30 


8.95 


91.05 


2.80 


6.15 


.48 


1.0211 


1.0200 


34.10 


40 


7.67 


92.33 


2.40 


5.27 


.40 


1.0192 


1.0167 


31.10 


50 


6.43 


93.57 


2.00 


4.43 


.38 


1. 0154 


1.0140 


28.45 



Coloring matters. — All of the samples of milk were examined sys- 
tematically for artificial coloring matters by the methods given by 
Leach (10). 

Preservatives. — All of the samples of milk were examined for anti- 
septics (1) by the souring test. That is, a portion of the sample 
was placed in a flask and allowed to stand overnight at room temper- 



400 

ature. If the milk turns sour in this time and curdles normally it 
was taken as an indication that antiseptics had probably not been 
added. On the other hand, if it did not curdle in this time, under 
these conditions, it was regarded as possibly containing preserva- 
tives and was systematically examined for all substances ordinarily 
employed as milk preservatives by the methods described by Leach, 
Van Slyke, and other well-known authorities on the subject. 

(2) A considerable number of the samples were tested for preserva- 
tives by Blyth's (11) method for the detection and estimation of pre- 
servatives in milk. This method is carried out in the following man- 
ner: Ten cubic centimeters of the milk is put into a clean, wide test 
tube, and into another tube for purposes of comparison and control 
are put 10 cubic centimeters of a sample of milk of known purity. To 
each tube 2 cubic centimeters of a strong aqueous solution of blue 
litmus is then added, and after plugging with cotton wool the tubes 
are sterilized by heating to 80° C. for ten minutes. The tubes are 
then removed from the sterilizer and cooled to ordinary temperature. 
Each tube is then inoculated with 0.5 cubic centimeter of a solution 
containing 0.5 cubic centimeter of sour milk and 100 cubic centimeters 
of water. After thoroughly mixing, the tubes are kept at 15° to 25° 
C. for twenty-four hours and are then examined. The tubes contain- 
ing samples of milk which contain preservatives will be colored blue 
or pink, whereas the tubes containing milks to which no preservatives 
have been added will be of the same color as the control experiment 
with normal milk, viz, white or nearly so. This test depends upon 
the fact that in the normal souring of milk the colored substances 
present in litmus are reduced by the bacteria to colorless (leuco) com- 
pounds. 

(3) All of the samples of milk without exception were tested for 
formaldehyde and boric acid by the methods described by Leach 
(12). The test for formaldehyde described by this author as the 
hydrochloric acid test is capable of readily detecting 1 part of for- 
maldehyde in 250,000 parts of sweet milk and 1 part in 50,000 in 
sour milk. It has been shown by Rideal and Foulerton (13) that at 
least 1 part of formaldehyde in 50,000 is required to preserve milk 
for twenty-four hours, so that this test is capable of detecting much 
smaller quantities of formaldehyde than is ever employed in prac- 
tice. During the month of September, during which time special 
attention was paid to the subject of preservatives in the milk, 20 
cubic centimeters of each sample of the milk was distilled and a few 
cubic centimeters of the distillate collected in a small amount of dis- 



401 

tilled water. The distillate was then tested for formaldehyde by a 
modification of the Hehner test (see Acree (14) ), which in our hands 
enabled us to detect with certainty 1 part of formaldehyde in 1,000,000 
parts of milk when a few drops of normal milk are used to supply 
the proteid required in this test. 

In Table I are given the results of our analyses. 

In Table II, column (1), are given the serial numbers of the sam- 
ples of the milks of the several dairies. These are the inspectors' 
numbers furnished by the health office of the District of Columbia. 
In column (2) are given the total number of samples analyzed from 
each dairy. In column (3), the inspectors' numbers of such samples 
as were found to be below the standard of purity now fixed for the 
District of Columbia. In column (4), the total number of samples 
found to be below this standard. In column (5) are given the in- 
spectors' numbers of the samples which were found to contain measur- 
able amounts of dirt, viz, quantities equal to or greater than 0.07 per 
cent by volume of the milk. In column (6) are given the total num- 
ber of milks from each dairy containing measurable amounts of dirt. 

It will be seen from the totals given at the end of Table II that out 
of a total of 452 samples of milk analyzed 55 were found to be below 
standard, and of these which were found to be below standard 48 
contained less than 3.5 per cent of fat and IT gave evidence of having 
been watered. In addition to the 55 samples found to be below 
standard, 4 samples gave results indicating the probability of their 
having been watered, and 2 of the samples had probably been 
skimmed. It will also be seen from Table II that out of 452 samples 
analyzed 242 contained measurable amounts of dirt, varying from 
0.07 per cent by volume of the milk to ten times this amount, viz, 0.7 
per cent by volume. Only one of the samples out of the 452 ana- 
lyzed was found to contain preservatives. This particular sample 
contained small amounts of boric acid. None of the samples con- 
tained artificial coloring matters. The following additional facts 
concerning certain of these samples are not without interest in this 
connection: Samples 148B, 235B, 240B, 241B, 280B, 297B, 1C, 2C, 
8C, 44C, 58C, and 60C were put up in bottles containing stale milk. 
Samples 48A, 196B, 203B, 216B, and 237B were put up in dirty bottles. 
Feces were found in sample HOB, grass in sample 121B, pieces of 
straw in samples 51A, 57B, 144B, 154B, 169B, 215B, and 220B. 
Pieces of hair were found in samples 49A, 77B, 147B, 181B, and 198B. 
A blue substance, probably laundry bluing, was found in sample 155B ; 
45276°— Bull. 56—12 26 



402 

and pieces of leaves in samples 121B and 196B ; and one or more dead 
flies in samples 43B, 56B, and 252B. 

Samples 28A, 4B, 29B, 51B, 91B, HOB, 132B, 154B, 179B, 189B, 
199B, 208B, 234B, 247B, 248B, 255B, 277B, 21C, and 38C were found 
to contain more than 0.18 per cent of lactic acid. 

Finally a word or two should be said as to the general import of 
these adulterations of the Washington milk supply. First, the fact 
that 48 of the samples analyzed contained less than 3.5 per cent of 
fat is not in itself a matter of serious import, for the reason that the 
milk of perfectly healthy cows frequently contains less than 3.5 per 
cent of fat, and yet no one could question the value of such milk as 
a food. Then again, we note that the requirements here in the Dis- 
trict of Columbia regarding the fat content of milk are higher than 
the United States standard controlling the composition of milk 
offered for sale under the laws governing interstate commerce. This 
in itself may indicate possibly that the requirements governing the 
percentage of fat in milk within the District of Columbia are a trifle 
too high. 

As already pointed out, the watering of milk is a practice which 
should be vigorously condemned and controlled by rigorous enforce- 
ment of the law, for the reason that such practice is not only fraudu- 
lent, but also a serious menace to the health of the community by 
reason of the fact that the milk may become infected with patho- 
genic organisms as the result of the addition of polluted water, and 
ordinarily the dairyman who waters his milk does not stop to con- 
sider the character of the water which he is adding thereto. In fact 
the degree of water pollution which might seriously contaminate and 
infect a milk supply, if the water were added to the milk, would 
probably under most circumstances be exceedingly difficult to detect. 
The only way therefore to control such a situation is simply to pre- 
vent by law the addition of water to milk in any form. According 
to Atlee (15), impure water is one of the most frequent sources 
of the pollution of milk, resulting either from the addition of water 
for purposes of adulteration or from its use for washing utensils. 
Winslow (16) is also of the opinion that water is probably the most 
dangerous adulterant of milk, for the reason that the water used by 
dairymen is frequently dirty and contaminated with pathogenic 
organisms. 

From the standpoint of public health the point of chief interest 
and of the greatest importance brought out in this investigation 
is the large number of milks sold in Washington containing meas- 
urable amounts of dirt. Two hundred and forty-two samples out 



403 

of 452, or 53.5 per cent of all the samples examined, contained 0.07 
per cent, or more, of dirt by volume of the milk. Many more of 
the samples contained traces of dirt, and comparatively few were 
absolutely clean. During the summer of 1906, of 172 samples of 
milk examined in the Division of Pathology and Bacteriology of 
the Hygienic Laboratory, 98 samples were found to contain a very 
small amount of dirt. Eight contained much dirt, and 1 contained 
(mouse?) feces. (See Bulletin 35, Hygienic Laboratory, United 
States Public Health and Marine-Hospital Service, p. 71.) All 
sanitarians are agreed that milk should contain no dirt, and by the 
use of the Gurler milk pail in milking, and by taking a few simple 
precautions in the handling and preservation of milk it can certainly 
be kept out, and a good clean milk delivered to the consumer. 

The presence of dirt in such a large percentage of the samples 
examined indicates an alarming neglect of even the simplest precau- 
tions, and probably accounts for the large number of bacteria found 
in the greater number of milks on sale in the city of Washington 
during the summer months. According to Renk (quoted by Ott (5) ) , 
cow's milk should be put on the market in such a state of purity that 
after two hours' standing a liter of the milk should show no appre- 
ciable deposit. Very few of the milks offered for sale in this city 
would conform to this requirement. 

It should be observed in this connection, however, that dirty milk 
is by no means confined to this locality. Nearly every city through- 
out the world has to contend with this problem. According to some 
authorities, the citizens of Berlin consume 300 pounds of cow dung 
in their milk daily, and the citizens of New York consume 10 tons of 
filth and refuse in the same manner; and many medical authorities, 
among them Winslow (16), assert that the question of dirt and the 
bacterial contamination of milk is of infinitely greater importance 
from the standpoint of health than a high chemical standard gov- 
erning the composition of milk, for the reason that very poor milk, 
viz, that which is low in proteids, fat, and milk sugar, is still very 
valuable as a food and contains a great deal of nutriment, provided 
that it is sufficiently clean to be consumed with safety. On the other 
hand, it is now perfectly well understood that dirty milk and milk 
bacterially contaminated is not only responsible for the high death 
rate prevailing among young children from cholera infantum, but 
that polluted milk is also responsible to a large degree for the spread 
of such infections as diphtheria, scarlet fever, typhoid fever, and 
tuberculosis, and for acute cases of milk poisoning, which are by no 
means uncommon. 



404 

It is therefore not surprising that some medical authorities (IT) 
have gone so far as to express a preference for milk containing cer- 
tain antiseptics, especially small amounts of formaldehyde, to the 
germ-laden milk ordinarily supplied the consumer in cities, and, for 
that matter, in many places in the country and even on the farm. 
The following communications on the subject of impure and dirty 
milk contain suggestions of great practical value: 

" Impure milk and its evils," J. H. Atlee, Trans. Med. Soc. Tenn. 1897, 54-61. 

" The clean-milk problem," Winslow, Northwest Medicine, Seattle, 1904, II, 
315-327. 

" Sources, effects, and prevention of dirty milk," Harrington, Amer. Jour. Pub. 
Hyg., 1904, 14, 31-55. 

" Certified milk and the general milk supply of Louisville," Tuley, Jour. Amer. 
Med. Assn., 1907, 49, 1344-1349. 

While it is more or less foreign to the general scope of this com- 
munication to discuss the economics of the milk question, it may 
not be amiss to point out that the production of clean, wholesome 
milk is largely a matter of cost and education. Medical authorities 
and practical dairymen and milk producers have alike, and more or 
less independently, arrived at the conclusion that clean, cold milk of 
a high grade of purity can not be sold to the consumer at less than 
from 8 to 10 cents a quart, and that in a number of instances where 
the production of such milk has been tried it had only a limited 
sale at 10 cents per quart, on account of the general apathy of even 
those persons well able to afford to pay this price. It is evident, 
therefore, that not only the dairyman, but also the general public, 
is in need of education regarding the necessity for a purer milk 
supply. It is also evident that a price of 8 to 10 cents a quart 
probably puts milk beyond the reach of the poorer classes. There 
are those who are of the opinion that pure high-grade milk can not 
be supplied to the poorer classes except by private philanthropy or 
municipal aid. 

The fact that the Washington milk supply is practically free from 
preservatives and artificial coloring matters is one point in its favor. 
Thus considerable toward its purification and betterment has already 
been accomplished by the health officer of the District by the strict 
enforcement of the law regulating this subject. I understand that 
the results of the analyses of the Washington milk supply made in 
the health office and the Bureau of Chemistry, U. S. Department of 
Agriculture, practically confirm the results reached in the Division 
of Chemistry of the Hygienic Laboratory regarding the freedom of 
the milk from preservatives and artificial coloring matters. 



405 



Table I. — Analyses of milk sold in Washington and the District of Columbia. 
[Hygienic Laboratory, Division of Chemistry, July 5, 1907, to September 28, 1907, inclusive.] 



No. of 
sam- 
ple. 


Date. 


Specific 
gravity. 


Fat. 


Total 
solids. 


Solids 
not fat. 


Ash. 


Milk 
sugar. 


Acidity. 


Sedi- 
ment. 


Re- 

fracto- 
meter 
reading. 




1907. 




















1A 


July 5 


1.0288 


4.0 


14 11 


10.11 


0.58 










2A 


....do... 


1. 0335 


3.8 


13.89 


10.09 


.62 










3A 


.. .do . 


1. 0315 
1. 0308 
1. 0298 
1. 0327 
1.030 


3.6 
3.5 
4.0 
3.3 

4.4 


11.83 
12.50 
12.94 
12.72 
14 20 


8.23 

9.0 

8.94 

9.42 

9.8 


.637 

.62 

.60 

.66 

.65 










4A... . 


do ... 










5A... . 


. .do . . 










6A... 


.do . . 










7A 


July 6 






(a) 




8A 


....do... 


1.031 

1. 0256 

1. 0313 

1.030 

1.029 

1.032 

1.029 

1.033 

1.031 

1.031 


4 25 

4.3 

4.0 

4.0 

3.7 

3.9 

3.8 

3.8 

2.8 

3.8 


13.72 
12.88 
13.41 
12.49 
12.05 
8.97 
14 87 
13.59 
11.29 
12.54 


9.47 
8.58 
9.41 
8.49 
8.35 
5.07 
11.07 
9.79 
8.49 
8.74 


.62 
.70 
.81 
.64 
.61 
.68 
.67 
.60 
.64 
.71 






(a) 

None. 

( 6 ) 

( b ) 
None. 

( 6 ) 
(a) 
(a) 

None. 




9A 


....do... 








10A.... 


....do... 
....do... 








11A.... 








12A.... 


July 8 
do ... 


4 51 
4 90 
4.56 
4.99 
4 71 
4.68 




41.3 


13A.... 




40.5 


14A 


do . . 




39.5 


15A-... 


....do... 
....do... 




42.5 


16A.... 




41.0 


17A.... 


July 9 


0.133 


42.2 


18A.... 


....do... 


1.032 


3.15 


12.30 


9.15 


.70 


4.57 


.141 


( c ) 


41.5 


19A.... 


....do... 


1.032 


4.8 


14 10 


9.30 


.71 


4 06 


.153 


( c ) 


43.0 


20A-... 


....do... 


1.031 


4.4 


13.47 


9.07 


.65 


4 93 


.162 


( 6 ) 


41.7 


21A.... 


....do... 


1. 0315 


3.8 


12.40 


8.6 


.70 


4 70 


.155 


(a) 


41.26 


22A.... 


July 10 


1.030 


4.2 


15.13 


10.93 


.71 


4 76 


.134 


( b ) 


41.3 


23A.... 


....do... 


1.031 


4.8 


13.87 


9.07 


.68 


4 59 


.137 


(a) 


41.5 


24A.... 


....do... 


1. 0257 


3.1 


10.62 


7.52 


.57 


3.69 


.122 


( c ) 


36.5 


25A.... 


....do... 


1.030 


40 


12.68 


8.68 


.65 


4 67 


.141 


(a) 


41.5 


26A.... 


....do... 


1.031 


3.8 


12.35 


8.55 


.63 


4 69 


.130 


None. 


41.5 


27A.... 


July 11 


1. 0312 


44 


13.34 


8.94 


.73 


4 55 


.146 


( 6 ) 


42.4 


28A.... 


....do... 


1. 0294 


5.0 


13.83 


8.83 


.65 


4 61 


.185 


(a) 


42.25 


29A.... 


....do... 


1.031 


5.0 


14 35 


9.35 


.65 


4 90 


.158 


(») 


43.2 


30A.... 


....do... 


1. 0328 


46 


14 00 


9.40 


.68 


4.83 


.150 


( c ) 


43.5 


31A.... 


....do... 


1.031 


3.2 


12.31 


9.11 


.66 


4 63 


.141 


None. 


42.1 


32A.... 


July 12 


1.033 


3.6 


13.00 


9.4 


.75 


4 91 


.157 


( c ) 


43.5 


33A.... 


....do... 


1.029 


5.0 


13.30 


8.30 


.68 


3.97 


.135 


(a) 


40.0 


34A.... 


....do... 


1.031 


4 95 


12.23 


7.28 


.63 


4 46 


.137 


None. 


41.2 


35A.... 


....do... 


1.030 


3.8 


12.60 


8.8 


.60 


4 46 


.137 


( c ) 


41.0 


36A.... 


....do... 


1.034 


3.5 


12.49 


8.99 


.67 


5.05 


.140 


( b ) 


42.5 


37A 


do . 


1.031 


3.7 


12.92 


9.22 


.67 


4.90 


157 


( c ) 


41.2 


38 A.. . 


. do 


1.029 


48 


12.48 


7.68 


63 


4 74 


130 


40 5 


39A.... 


....do... 


1. 0284 


44 


13.52 


9.12 


.70 


4 85 


.131 


(») 


41.6 


40A.... 


July 13 


1.030 


3.8 


12.83 


9.03 


.67 


4 76 


.135 


0.13 


40.5 


41A.... 


....do... 


1.033 


3.0 


12.55 


9.55 


.59 


4.85 


.141 


.20 


41.2 


42A 


do . 


1.030 


3.7 


12.59 


8.89 


.58 


4 65 


141 




40 


43A.... 


....do... 


1.032 


42 


13.24 


9.04 


.62 


4 71 


.142 


.07 


41.3 


44A.... 


....do... 


1.033 


4.6 


13.64 


9.04 


.55 


4 91 


.178 


.07 


42.5 


45A.... 


July 15 


1.031 


46 


13.78 


9.18 


.67 


4 62 


.144 


Trace. 


42.25 


46A.... 


....do... 


1.033 


46 


14 37 


9.77 


.72 


4 60 


.137 


Trace. 


43.0 


47A.... 


July 15 


1.033 


4.4 


13.76 


9.36 


.65 


4.87 


.158 


.33 


40.5 


48Ad... 


....do... 


1.030 


3.1 


11.73 


8.63 


.60 


4.69 


.142 


.13 


44.0 


49A«... 


....do... 


1.033 


3.8 


13.0 


9.2 


.67 


4.93 


.149 


.06 


42.0 



Slight. 



b Very slight. 



c Considerable. 



d Full of dirt. 



e Contained hair. 



406 

Table I. — Analyses of milk sold in Washington and the District of Columbia — Cont'd. 



No. of 
sam- 
ple. 


Date. 


Specific 
gravity. 


Fat. 


Total 
solids. 


Solids 
not fat. 


Ash. 


Milk 
sugar. 


Acidity. 


Sedi- 
ment. 


Re- 

fracto- 
meter 
reading. 


50A.... 


1907. 
July 15 


1.032 


3.0 


11.65 


8.65 


.61 


4.77 


.139 


.13 


42.0 


51A«... 


....do... 


1.032 


4.0 


13.44 


9.44 


.66 


5.40 


.148 


.13 


43.0 


52A.... 


July 16 


1.030 


3.4 


12.31 


8.91 


.71 


4.78 


.142 


Trace. 


41.25 


53A.... 


....do... 


1.031 


4.0 


12.89 


8.89 


.69 


4.61 


.139 


Trace. 


41.0 


54A.... 


....do... 


1.032 


3.8 


13.06 


9.26 


.69 


4.96 


.166 


.13 


43.0 


55A&... 


....do... 


1.031 


3.1 


12.26 


9.16 


.70 


4.46 


.137 


.20 


42.0 


56A.... 


....do... 


1.031 


4.2 


13.14 


8.94 


.67 


4.73 


.139 


.07 


42.0 


57A.... 


....do... 


1.029 


2.4 


11.81 


9.41 


.61 


4.44 


.128 


.27 


39.0 


58A.... 


....do... 


1.033 


4.6 


14.27 


9.67 


.67 


4.81 


.139 


Trace. 


42.5 


59A.... 


July 17 


1. 0285 


6.6 


12.89 


6.29 


•74 


4.66 


.15 


.07 


42.0 


60A.... 


....do... 


1.0303 


4.2 


13.28 


9.08 


.73 


4.55 


.140 


Trace. 


40.5 


61A.... 


....do... 


1. 0322 


4.2 


13.80 


9.60 


.73 


4.81 


.121 


Trace. 


41.4 


62A.... 


....do... 


1. 0312 


3.8 


13.12 


9.32 


.73 


4.50 


.138 


Trace. 


41.0 


63A.... 


....do... 


1.0312 


4.6 


12.49 


7.89 


.72 


4.28 


.137 


Trace. 


42.0 


64A.... 


....do... 


1. 0281 


4.0 


11.86 


7.86 


.62 


4.12 


.139 


.33 


38.5 


65A.... 


....do... 


1. 0323 


4.6 


14.20 


9.60 


= 71 


4.90 


.142 


.20 


43.0 


66A.... 


....do... 


1. 0303 


5.6 


14.15 


8.55 


.68 


4.74 


.135 


.13 


41.5 


67A,... 


July 18 


1.0289 


4.1 


12.37 


8.27 


.66 


4.30 


.139 


Trace. 


40.1 


68A.... 


....do... 


1.029 


3.4 


11.59 


8.19 


.67 


4.51 


.130 


Trace. 


39.4 


69A.... 


....do... 


1.0326 


4.8 


15.06 


10.26 


.71 


4.29 


.158 


.07 


43.5 


70A.... 


....do... 


1. 0275 


5.4 


13.13 


7.73 


.63 


4.31 


.126 


.20 


39.0 


71A.... 


....do... 


1. 0315 


4.2 


13.24 


9.04 


.67 


4.75 


.146 


.13 


42.2 


72A 


....do... 


1. 0297 
1. 0324 


5.8 
5.0 


14.49 
14.07 


8.69 
9.07 


.66 
.75 


4.78 
4.56 


.149 
.144 


.20 
.07 


41.2 


73A.... 


July 19 


42.0 


74A.... 


....do... 


1. 0315 


3.6 


12.34 


8.74 


.67 


4.75 


.137 


Trace. 


41.0 


75A.... 


....do... 


1. 0312 


4.3 


13.55 


9.25 


.69 


4.61 


.140 


.20 


41.1 


76A---- 


....do... 


1. 0323 


4.0 


13.16 


9.16 


.71 


4.94 


.135 


.33 


42.0 


77A.... 


....do... 


1. 0314 


3.7 


12.68 


8.98 


.66 


4.73 


.142 


.33 


40.5 


78A.... 


....do... 


1. 0263 


3.0 


10.12 


7.12 


.49 


3.77 


.177 


.07 


36.5 


79A.... 


July 22 


1. 0315 


3.2 


12.77 


9.57 


.71 


4.77 


.135 


.07 


41.3 


80A.... 


....do... 


1. 0319 


4.1 


13.02 


8.92 


.67 


4.48 


.137 


.26 


41.0 


81A.... 


....do... 


1. 0309 


4.6 


13.69 


9.09 


.65 


4.92 


.157 


Trace. 


41.7 


82A.... 


....do... 


1.032 


3.4 


12.21 


8.81 


.70 


4.94 


.137 


.13 


41.5 


83A.... 


....do... 


1. 0324 


4.3 


13.36 


9.06 


.67 


4.93 


.142 


Trace. 


42.0 


84A.... 


....do... 


1. 0313 


4.2 


12.61 


8.41 


.60 


4.63 


.146 


Trace. 


42.5 


85A.... 


....do... 


1. 0228 


9.2 


16.85 


7.65 


.52 


4.22 


.140 


.33 


39.5 


IB.... 


July 23 


1. 0314 


3.6 


11.80 


8.2 


.65 


4.59 


.137 


Trace. 


41.0 


2B.... 


....do... 


1.032 


5.6 


14.27 


8.67 


.65 


4.94 


.146 


Trace. 


43.0 


3B.... 


....do... 


1. 0278 


3.5 


12.81 


9.31 


.62 


4.18 


.121 


.07 


38.5 


4B.... 


....do... 


1. 0319 


4.6 


12.95 


8.35 


.68 


4.63 


.216 


.07 


41.5 


5B.... 


....do... 


1. 0315 


5.4 


13.59 


8.19 


.67 


4.63 


.153 


Trace. 


42.0 


6B.... 


....do... 


1.024 


8.0 


14.08 


6.08 


.58 


4.14 


.119 


Trace. 


37.8 


7B.... 


....do... 


1.029 


5.4 


12.83 


7.43 


.63 


4.68 


.169 


.13 


40.5 


8B.... 


July 24 


1. 0301 


4.5 


13.21 


8.71 


.66 


4.96 


.130 


Trace. 


41.5 


9B.... 


....do... 


1.030 


5.8 


14.50 


8.70 


.66 


4.91 


.139 


None. 


41.5 


10B.... 


....do... 


1. 0327 


3.9 


12.60 


8.70 


.67 


5.00 


.139 


None. 


42.5 


11.B- — 


....do... 


1.032 


4.8 


13.85 


9.05 


.60 


4.71 


.162 


Trace. 


42.0 


12B.... 


....do... 


1. 0315 


3.8 


12.73 


8.93 


.658 


4.79 


.139 


.13 


41.7 


13B.... 


....do... 


1. 0305 


4.4 


12.75 


8.35 


.67 


4.78 


.133 


.07 


41.0 


14B.... 


....do... 


1. 0315 


3.8 


12.59 


8.79 


.67 


4.48 


.137 


.07 


41.5 


15B 


July 24 


1. 0315 


4.3 


12.84 


8.54 


.67 


4.75 


.131 


Trace. 


41.1 


16B.... 


July 25 


1.032 
a Pieces 


4.4 
of stra^ 


12.79 
v. 


8.39 


.66 
bLarg 


4.69 
r e black 


.140 
particles. 


.33 


42.0 



407 

Table I. — Analyses of milk sold in Washington and the District of Columbia — Cont'd. 



No. of 
sam- 
ple. 


Date. 


Specific 
gravity. 


Fat. 


Total 
solids. 


Solids 
not fat. 


Ash. 


Milk 

sugar. 


Acidity. 


Sedi- 
ment. 


Re- 

fracto- 
meter 
reading. 




1907. 




















17B.... 


July 25 


1. 0303 


7.2 


15.44 


8.24 


.69 


4.53 


.151 


.13 


41.5 


18B.... 


....do... 


1. 0313 


4.8 


12.96 


8.16 


.66 


4.90 


.138 


Trace. 


42.0 


19B.... 


....do... 


1. 0324 


5.0 


13.92 


8.92 


.67 


5.04 


.155 


.13 


42.5 


20B.... 


....do... 


1. 0285 


7.6 


15.00 


7.40 


.59 


4.82 


.133 


Trace. 


42.1 


21B.... 


....do... 


1. 0329 


5.4 


13.78 


8.38 


.68 


4.87 


.137 


.07 


41.0 


22B 


....do... 


1. 0309 

1.034 


4.8 
4.6 


12.71 
12.90 


7.91 
8.30 


.71 
.67 


4.69 
5.09 


.159 
.157 


None. 
.33 


41.2 


23B.... 


....do... 


43.0 


24B.... 


July 26 


1.0316 


3.4 


12.84 


9.44 


.70 


5.04 


.148 


.07 


42.0 


25B.... 


....do... 


1. 0316 


3.5 


12.13 


8.63 


.68 


4.88 


.137 


.07 


41.0 


26B . . . . 


....do... 


1.0277 


3.8 


11.61 


7.81 


.58 


4.20 


.119 


• .20 


39.0 


27B . . . . 


....do... 


1.0317 


4.8 


13.82 


9.02 


.67 


4.92 


.153 


Trace. 


40.0 


28B . . . . 


....do... 


1. 0299 


3.5 


11.67 


8.17 


.66 


4.49 


.155 


.07 


40.0 


29B.... 


....do... 


1.0278 


4.8 


12.30 


7.50 


.48 


4.20 


.241 


Trace. 


39.0 


30B.... 


....do... 


1.030 


3.4 


11.63 


8.23 


.61 


4.43 


.146 


Trace. 


40.0 


32B.... 


July 29 


1. 0309 


5.7 


15.68 


9.98 


.69 


4.86 


.133 


.33 


41.5 


33B.... 


....do... 


1. 0318 


3.4 


12.40 


9.00 


.70 


4.52 


.155 


.20 


41.5 


34B . . . . 


....do... 


1.0323 


4.3 


14.07 


9.77 


.73 


4.90 


.157 


.13 


42.0 


35B . . . . 


....do... 


1.0314 
1.0316 
1. 0326 


3.5 
4.2 
3.4 


12.43 
13.79 
12.78 


8.93 
9.59 
9.38 


.68 

.74 
.72 


4.63 
4.94 
5.00 


.150 
.148 
.158 


.26 
.13 
.26 


41.0 


36B . . . . 


....do... 


42.5 


37B.... 


....do... 


42.2 


38B.... 


....do... 


1.0315 


4.0 


13.20 


9.20 


.72 


4.59 


.173 


.20 


41.5 


39B.... 


....do... 


1.0327 


3.8 


13.15 


9.35 


.71 


5.06 


.158 


Trace. 


42.0 


40B.... 


July 30 


1.033 


5.0 


15.51 


10.51 


.70 


4.85 


.145 


.07 


42.2 


41B.... 


....do... 


1.0316 
1. 0312 


4.8 
4.0 


14.67 
13.40 


9.87 
9.40 


.63 
.67 


5.00 
4.66 


.144 
.167 


Trace. 
.07 


41.5 


42B.... 


....do... 


40.5 


43B a. . . 


....do... 


1. 0301 
1. 0301 


4.8 
3.5 


14.73 
13.09 


9.93 
9.59 


.65 
.68 


5.11 
4.55 


.153 
.133 


Trace. 
.70 


42.0 


44B.... 


....do... 


41.5 


46B.... 


....do... 


1. 0305 


4.4 


13.06 


8.66 


.66 


4.44 


.150 


.33 


41.0 


49B.... 


July 31 


1. 0323 


4.6 


14.38 


9.78 


.68 


5.06 


.166 


.13 


42.0 


50B.... 


....do... 


1.0306 


5.0 


13.91 


8.91 


.68 


4.86 


.141 


.07 


41.0 


51B 


....do... 


1. 0325 
1. 0306 
1. 0316 
1. 0288 


3.5 
4.0 
3.8 

4.2 


12.59 
12.78 
13.90 
12.40 


9.09 
8.78 
10.10 
8.20 


.67 
.70 

.67 
.57 


4.83 
5.03 
4.90 
4.51 


.184 
.169 
.155 
.146 


Trace. 

.07 
Trace. 

.07 


40.0 


52B . . . . 


....do... 


40.3 


53B . . . . 


....do... 


40.7 


54B . . . . 


Aug. 1 


39.0 


55B . . . . 


....do... 


1. 0306 


4.8 


13.33 


8.53 


.61 


4.74 


.131 


.07 


40.2 


56B6... 


....do... 


1.0288 


3.1 


10.81 


7.71 


.54 


4.77 


.139 


Trace. 


38.3 


57Bc... 


....do... 


1. 0298 


4.4 


12.85 


8.45 


.63 


4.72 


.131 


.20 


40.5 


58B . . . . 


....do... 


1. 0279 


5.5 


12.82 


7.32 


.63 


4.24 


.142 


Trace. 


39.1 


59B.... 


....do... 


1.0315 


3.8 


12.50 


8.70 


.62 


4.81 


.131 


.13 


41.0 


60B.... 


....do... 


1.0305 


5.3 


13.60 


8.30 


.66 


4.77 


.140 


None. 


41.0 


61B.... 


....do... 


1.030 


3.1 


11.36 


8.26 


.61 


4.60 


.133 




39.3 


62B.... 


Aug. 2 


1. 0339 


4.0 


13.29 


9.29 


.72 


4.91 


.176 


Trace. 


42.0 


63B . . . . 


....do... 


1.0316 


4.7 


13.14 


8.44 


■ .69 


4.91 


.146 


.07 


41.0 


64B . . . . 


....do... 


1. 0305 


3.8 


12.24 


8.44 


.67 


4.70 


.144 


.13 


40.1 


65B . . . . 


....do... 


1. 0306 


2.6 


10.77 


8.17 


.64 


4.47 


.158 




39.0 


66B.... 


....do... 


1. 0288 


3.6 


11.03 


7.43 


.58 


4.39 


.130 


None. 


39.0 


67B.... 


....do... 


1. 0317 


4.4 


13.01 


8.61 


.65 


4.81 


.148 


.07 


41.0 


68B.... 


....do... 


1.031 


4.0 


13.57 


9.57 


.67 


^4.72 


.146 


None. 


41.2 


69B.... 


....do... 


1.031 


4.6 


13.03 


8.43 


.69 


4.70 


.149 


Trace. 


41.5 


70B.... 


Aug. 5 


1. 0317 


3.3 


12.61 


9.31 


.70 


4.93 


.157 


.07 


41.5 


71B.... 


....do... 


1.0315 


4.5 


13.31 


8.81 


.69 


4.72 


.144 


.13 


42.0 


72B.... 


....do... 


1.0325 


4.4 


13.28 


8.88 


.70 


4.87 


.149 


Trace. 


41.5 



a Two dead flies. 



1 Dead fly. 



c Pieces of straw. 



408 

Table I. — Analyses of milk sold in Washington and the District of Columbia — Cont'd. 



No. of 
sam- 
ple. 


Date. 


Specific 
gravity. 


Fat. 


Total 
solids. 


Solids 
not fat. 


Ash. 


Milk 
sugar. 


Acidity. 


Sedi- 
ment. 


Re- 

fracto- 
rneter 
reading. 




1907. 




















73B.... 


Aug. 5 


1. 0316 


4.0 


12.71 


8.71 


.68 


4.74 


.155 


.07 


41.0 


74B.... 


....do... 


1. 0327 


3.4 


12.38 


8.98 


.72 


4.51 


.144 


Trace. 


41.2 


75B . . . . 


....do... 


1. 0309 


4.2 


12.74 


8.54 


.63 


4.74 


.128 


Trace. 


41.0 


76B.... 


....do... 


1.031 


5.5 


14.05 


8.55 


.69 


4.70 


.137 


.07 


41.0 


77Ba .. 


....do... 


1.0319 


3.6 


12.52 


8.92 


.64 


4.77 


.164 


Trace. 


41.5 


78B . . . . 


Aug. 6 


1. 0313 


3.8 


13.43 


9.63 


.75 


5.12 


.167 


None. 


41.0 


79B.... 


....do... 


1.030 


4.2 


11.92 


7.72 


.61 


4.85 


.133 


.07 


39.0 


80B.... 


....do... 


1.0309 


5.5 


14.39 


8.89 


.64 


5.05 


.157 


.13 


42.0 


81B.... 


....do... 


1. 0269 


4.8 


11.84 


7.04 


.54 


4.20 


.117 


.13 


39.0 


82B.... 


....do... 


1. 0305 


3.6 


12.20 


8.60 


.62 


4.60 


.142 


.20 


40.0 


83B . . . . 


....do... 


1.0289 


4.0 


12.05 


8.05 


.58 


4.32 


.146 


.07 


39.0 


84B . . . . 


....do... 


1. 0269 


3.0 


10.25 


7.25 


.53 


3.95 


.130 


.13 


36.5 


85B . . . . 


....do... 


1.031 


5.2 


13.62 


8.42 


.73 


4.18 


.131 


.07 


41.0 


86B.... 


Aug. 7 


1. 0325 


4.7 


13.54 


8.84 


.64 


4.79 


.160 


.13 


41.5 


87B . . . . 


....do... 


1. 0327 


5.9 


15.31 


9.41 


.64 


5.08 


.166 


.07 


43.0 


88B . . . . 


....do... 


1. 0308 


3.7 


12.30 


8.60 


.63 


4.81 


.150 


.07 


40.3 


89B . . . . 


....do... 


1.032 


4.2 


13.00 


8.80 


.63 


4.77 


.158 


Trace. 


41.2 


90B.... 


....do... 


1. 0325 


3.8 


12.83 


9.03 


.61 


4.87 


.167 


Trace. 


42.0 


91B.... 


....do... 


1.031 


5.3 


13.67 


8.37 


.68 


4.49 


.205 


.13 


41.2 


92B.... 


....do... 


1.032 


4.3 


12.88 


8.58 


.65 


4.64 


.167 


.07 


41.5 


93B . . . . 


....do... 


1.031 


4.0 


12.45 


8.45 


.73 


4.81 


.135 


Trace. 


41.0 


94B . . . . 


Aug. 8 


1. 0313 


4.6 


13.48 


8.88 


.70 


4.66 


.149 


.07 


40.5 


95B . . . . 


....do... 


1. 0291 


4.8 


13.21 


8.41 


.58 


4.49 


.137 


Trace. 


38.5 


96B . . . . 


....do... 


1. 0322 


4.6 


13.64 


9.04 


.65 


5.01 


.159 


.13 


41.0 


97B.... 


....do... 


1. 0332 


4.2 


13.42 


9.22 


.65 


5.18 


.153 


Trace. 


42.0 


98B.... 


....do... 


1.0313 


4.3 


12.91 


8.61 


.65 


4.83 


.137 


Trace. 


41.0 


99B . . . . 


....do... 


1. 0335 


3.4 


12.30 


8.90 


.68 


4.77 


.151 


.07 


42.0 


100B... 


....do... 


1. 0305 


4.5 


13.05 


8.55 


.69 


4.70 


.151 


.13 


41.0 


101B... 


....do... 


1. 0326 


4.4 


13.04 


8.64 


.65 


5.10 


.149 


.20 


42.0 


102B... 


Aug. 9 


1. 0332 


4.4 


13.49 


9.09 


.68 


4.87 


.153 


Trace. 


42.5 


103B... 


....do... 


1. 0308 


4.2 


12.67 


8.47 


.61 


4.43 


.142 


.07 


40.0 


104B... 


....do... 


1.0319 


4.2 


13.20 


9.00 


.62 


4.32 


.149 


.07 


40.5 


105B... 


....do... 


1. 0315 


4.1 


13.12 


9.02 


.70 


4.68 


.144 


Trace. 


41.0 


106B... 


....do... 


1.031 


3.4 


12.09 


8.69 


.65 


4.74 


.155 


.07 


41.0 


107B... 


....do... 


1.031 


4.6 


13.39 


8.79 


.63 


4.74 


.148 


None. 


41.0 


108B... 


....do... 


1. 0315 


3.4 


12.95 


9.55 


.64 


4.60 


.158 


.07 


41.1 


109B... 


....do... 


1. 0301 


4.3 


11.59 


7.29 


.66 


4.28 


.130 


.07 


40.0 


HOB b . 


Aug. 12 


1. 0303 


3.8 


11.79 


7.99 


.62 


4.79 


.230 


Trace. 


40.0 


111B... 


....do... 


1. 0314 


3.8 


12.43 


8.63 


.66 


4.83 


.157 


.07 


41.0 


112B... 


....do... 


1. 0314 


3.6 


12.44 


8.84 


.62 


4.79 


.149 


.07 


40.0 


113B... 


....do... 


1.0314 


7.0 


14.92 


7.92 


.71 


4.62 


.139 


.33 


41.0 


114B... 


....do... 


1. 0253 


5.9 


14.06 


8.16 


.59 


4.20 


.131 


.20 


38.0 


115B... 


....do... 


1. 0329 


4.4 


13.29 


8.89 


.67 


4.77 


.148 


.07 


41.5 


116B... 


....do... 
....do... 


1. 0317 
1. 0327 


3.6 
4.2 


12.14 
13.41 


8.54 
9.21 


.61 
.51 


4.70 
5.16 


.158 
.167 




41.0 


117B... 


.33 


42.0 


119B... 


Aug. 13 


1. 0271 


2.9 


10.46 


7.56 


.64 


3.97 


.129 


.07 


36.5 


120B... 


....do... 


1.032 


4.0 


12.99 


8.99 


.69 


4.91 


.151 


Trace. 


40.1 


121B <- . 


....do... 


1.031 


4.1 


12.58 


8.48 


.70 


4.74 


.139 


None. 


39.5 


122B... 


....do... 


1.033 


4.6 


* 13. 74 


9.14 


.73 


4.79 


.146 


None. 


42.0 


123B... 


....do... 


1.030 


4.0 


12.71 


8.71 


.72 


4.54 


.146 


.20 


41.5 


124B... 


....do... 


1. 0312 


3.8 


13.13 


9.33 


. -75 


4.74 


.144 


.13 


41 


126B... 


....do... 


1. 0301 


4.2 


12.88 


8.68 


.71 


4.99 


.133 


None. 


41.0 




a] 


lair. 




& Containe 


d feces. 




cCo 


ntained gi 


ass. 





409 

Table I. — Analyses of milk sold in Washington and the District of Columbia — Cont'd. 



No. of 
sam- 
ple. 


Date. 


Specific 
gravity. 


Fat. 


Total 
solids. 


Solids 
not fat. 


Ash. 


Milk 
sugar. 


Acidity. 


Sedi- 
ment. 


Re- 

fracto- 

meter 

reading. 


127B... 


1907. 

Aug. 14 


1.0298 


4.2 


12.67 


8.47 


.65 


4.64 


.158 


.13 


41.0 


128B... 


....do... 


1. 0314 


4.0 


13.04 


9.04 


.70 


4.87 


.162 


.33 


41.5 


129B... 


....do... 


1.0303 


5.0 


14.07 


9.07 


.64 


4.87 


.140 


Trace. 


41.0 


130B... 


....do... 


1.030 


3.5 


12.10 


8.60 


.66 


4.64 


.149 


.07 


40.0 


131B... 


....do... 


1. 0294 


4.8 


13.36 


8.56 


.63 


4.81 


.158 


.27 


41.0 


132B . . . 


....do... 


1. 0285 


6.8 


14.83 


8.03 


.62 


4.22 


.204 


.13 


42.0 


133B . . . 


Aug. 14 


1. 0332 


4.0 


13.39 


9.39 


.69 


4.66 


.144 


Trace. 


43.0 


134B . . . 


....do... 


1.0215 


19.0 


21.79 


2.79 


.57 


4.77 


.157 


.33 


42.5 


135B... 


Aug. 15 


1.0308 


3.6 


12.03 


8.43 


.68 


4.70 


.144 


.13 


40.0 


136B . . . 


....do... 


1. 0285 


3.6 


12.18 


8.58 


.69 


4.62 


.166 


.07 


40.2 


137B . . . 


....do... 


1.0314 


4.4 


12.24 


7.84 


.62 


4.39 


.122 


.20 


38.5 


138B... 


....do... 


1.0296 


2.6 


10.30 


7.70 


.66 


4.64 


.140 




38.0 


139B... 


....do... 


1.0315 


3.5 


12.27 


8.77 


.71 


4.60 


.140 


.33 


40.0 


140B... 


....do... 


1. 0325 


4.5 


13.27 


8.77 


.72 


4.87 


.160 




42.0 


141B... 


....do... 
....do... 


1. 0312 
1.0298 


4.4 
3.6 


13.06 
11.69 


8.63 
8.09 


.67 

.62 


4.74 
4.74 


.171 
.142 




41.8 


142B... 




40.0 


144B a . 


Aug. 16 


1. 0271 


8.7 


16.59 


7.89 


.60 


4.41 


.173 


.13 


41.0 


145B... 


....do... 


1.0327 


4.4 


13.67 


9.27 


.62 


5.23 


.166 


None. 


42.0 


146B . . . 


....do... 


1. 0327 


5.4 


14.62 


9.22 


.66 


5.23 


.142 


.26 


42.0 


147B&.. 


....do... 


1.0339 


4.0 


13.44 


9.44 


.62 


5.18 


.166 


.13 


42.2 


148B c._ 


....do... 


1. 0278 


3.6 


11.65 


8.05 


.55 


4.74 


.131 


Trace. 


41.5 


149B . . . 


....do... 


1.0308 


4.2 


12.73 


8.53 


.55 


4.91 


.142 


Trace. 


39.0 


150B . . . 


....do... 


1. 0298 


4.4 


12.78 


8.38 


.51 


4.64 


.146 


.13 


39.0 


152B . . . 


....do... 


1.0299 


4.7 


12.72 


8.02 


.54 


4.72 


.149 


.0 r < 


39.2 


153B... 


Aug. 19 


1. 0305 


3.8 


12.51 


8.71 


.65 


4.83 


.142 


.0/ 


41.2 


154Ba.. 


....do... 


1. 0293 


4.2 


12.40 


8.20 


.654 


4.54 


.248 


.13 


40.5 


155B<*.. 


....do... 


1.0314 


3.6 


12.48 


8.88 


.66 


4.74 


.144 


.13 


40.3 


156B... 


....do... 


1. 0294 


3.6 


11.88 


8.28 


.60 


4.66 


.142 


.07 


40.0 


157B... 


....do... 


1. 0305 


3.8 


12.24 


8.44 


.716 


4.72 


.133 


Trace. 


39.0 


158B... 


....do... 


1. 0286 


3.8 


11.31 


7.51 


.57 


4.41 


.135 


.07 


40.0 


159B . . . 


....do... 


1. 0315 


3.6 


12.426 


8.826 


.67 


4.72 


.148 


.13 


41.0 


160B . . . 


....do... 


1. 0315 


3.6 


12.45 


8.85 


.638 


4.91 


.151 


.07 


42.0 


161B . . . 


Aug. 20 


1.032 


3.7 


12.46 


8.76 


.66 


5.08 


.153 


.07 


41.0 


162B... 


....do... 


1.032 


4.6 


13.66 


9.06 


.70 


4.95 


.144 


.20 


41.2 


163B... 


....do... 


1.033 


4.4 


13.31 


8.91 


.694 


5.08 


.157 


.07 


42.0 


164B . . . 


....do... 


1.0315 


4.2 


13.12 


8.92 


.714 


4.97 


.149 


Trace. 


41.5 


165B . . . 


....do... 


1.032 


3.8 


12. 926 


9.126 


.716 


4.89 


.153 


.53 


41.0 


166B... 


....do... 


1.033 


4.6 


13.54 


8.94 


.66 


5.14 


.135 


.07 


42.0 


167B . . . 


....do... 


1.031 


4.2 


12.71 


8.51 


.69 


4.87 


.131 


.07 


40.8 


168B... 


....do... 


1.030 


5.3 


13.67 


8.37 


.69 


4.93 


.140 


None. 


41.0 


169B«.. 


Aug. 21 


1. 0299 


4.0 


12.70 


8.70 


.73 


4.45 


.139 


.20 


40.0 


171B... 


....do... 


1.031 


4.1 


13.15 


9.05 


.71 


4.97 


.140 


.07 


41.0 


172B... 


....do... 


1. 0325 


3.8 


13.04 


9.24 


.66 


5.16 


.149 


.13 


41.0 


173B... 


....do... 


1.031 


3.0 


12.07 


9.07 


.67 


4.70 


.139 


.40 


40.2 


174B... 


....do... 


1.031 


3.6 


12.70 


9.10 


.70 


5.03 


.151 


.07 


40.6 


175B... 


....do... 


1. 0308 


3.8 


12.58 


8.78 


.72 


4.77 


.139 


Trace. 


41.0 


176B... 


....do... 


1.0268 


5.3 


13.66 


8.36 


.53 


4.49 


.155 


Trace. 


39.0 


178B... 


Aug. 22 


1.031 


6.1 


14.88 


8.78 


.65 


5.01 


.133 


.07 


43.0 


179B... 


....do... 


1.035 


4.8 


14.27 


9.47 


.69 


5.33 


.190 


Trace. 


42.3 


180B... 


....do... 


1. 0306 


4.7 


13.11 


8.41 


.63 


4.91 


.133 


Trace. 


41.5 


181B6.. 


....do... 


1. 0316 


4.2 


12.83 


8.63 


.68 


5.12 


.173 


Trace. 


42.2 


oC( 


mtained s 


traw. b ( 


Fontaine 


d hair. 


; Stale mil 


k in bot 


tie. d 1 


31ue subst 


ance in be 


ttle. 



410 

Table I. — Analyses of milk sold in Washington and the District of Columbia — Cont'd. 



No. of 
sam- 



ple 



Date. 


Specific 
gravity. 


Fat. 


Total 
solids. 


Solids 
not fat. 


Ash. 


Milk 
sugar. 


Acidity. 


Sedi- 
ment. 


1907. 


















Aug. 22 


1.0302 


5.4 


14.13 


8.73 


.66 


4.87 


.158 


.13 


...do... 


1.0308 


4.3 


12. 474 


8.174 


.654 


4.62 


.142 


.07 


...do... 


1.0321 


4.2 


12.90 


8.70 


.69 


4.74 


.148 


.07 


...do... 


1. 0312 


3.8 


12.44 


8.64 


.69 


4.81 


.148 


.13 


Aug. 23 


1. 0336 


4.0 


13. 088 


9.088 


.72 


4.99 


.153 


Trace. 


...do... 


1.0298 


4.2 


12. 658 


8.458 


.67 


4.70 


.142 


.07 


...do... 


1. 0313 


4.0 


12.76 


8.76 


.69 


4.66 


.149 


.07 


...do... 


1. 0309 


3.8 


12.16 


8.36 


.69 


4.70 


.198 


.13 


...do... 


1.032 


4.8 


13. 634 


8.834 


.77 


4.91 


.146 


.13 


...do... 


1.0306 


4.8 


12.96 


8.16 


.70 


4.22 


.106 


.26 


Aug. 23 


1.0255 


6.0 


12.38 


6.38 


.60 


3.91 


.130 


.07 


...do... 


1. 0321 
1. 0294 


4.2 
4.6 


12.90 
12.54 


8.70 
7.94 


.67 
.67 


4.83 


.149 
.135 




Aug. 26 


.26 


...do... 


1.0325 


4.4 


13.33 


8.93 


.74 




.149 


.33 


...do... 


1.035 


5.7 


14.37 


8.67 


.70 




.160 


Trace. 


...do... 


1. 0326 


4.0 


12.91 


8.91 


.72 




.151 


.07 


...do... 


1. 0318 


5.0 


14.03 


9.03 


.70 




.135 


.08 


...do... 


1.033 


4.2 


13.59 


9.39 


.69 




.189 


Trace. 


...do... 


1.031 


5.6 


14.26 


8.66 


.57 




.165 


None. 


...do... 


1. 0314 


4.0 


12.68 


8.68 


.68 




.140 


.20 


Aug. 27 


1. 0305 


4.0 


12.63 


8.63 


.70 




.156 


.07 


...do... 


1. 0287 


3.8 


11.67 


7.87 


.66 




.120 


.33 


...do... 


1. 0315 


4.4 


13.17 


8.77 


.66 




.144 


.07 


.. .do... 


1. 0325 


3.9 


13.15 


9.25 


.71 




.171 


.13 


...do... 


1. 0305 


4.0 


12.54 


8.54 


.71 




.140 


.07 


...do... 


1. 0305 


4.0 


12.73 


8.73 


.61 




.151 


.13 


...do... 


1.0317 


5.0 


14.04 


9.04 


.76 




.182 


Trace. 


...do... 


1. 0291 


3.8 


12.01 


8.21 


.67 




.149 


.20 


Aug. 28 


1. 0294 


6.3 


13.94 


7.64 


.79 




.157 


None. 


...do... 


1. 0308 


5.0 


12.75 


7.75 


.69 




.153 


.13 


...do... 


1. 0283 


4.6 


11.78 


7.18 


.59 




.137 


Trace. 


...do... 


1.0314 


6.0 


13.99 


7.99 


.68 




.144 


None. 


...do... 


1. 0319 


4.6 


13.00 


8.40 


.71 




.146 


.07 


...do... 


1. 0304 


5.2 


12.99 


7.79 


.71 




.148 


.13 


...do... 


1. 0314 


5.6 


13.56 


7.96 


.76 




.155 


.13 


...do... 


1.0286 


4.3 


11.73 


7.43 


.63 




.155 




Aug. 29 


1.031 


4.5 


13.35 


8.85 






.149 


.07 


...do... 


1.031 
1. 0325 


3.4 
3.5 


11.92 
12.31 


8.52 
8.81 






.142 
.149 


.07 
.07 


...do... 


.73 




...do... 


1. 0307 


4.0 


12.20 


8.20 


.69 




.124 


Trace. 


...do... 


1.0295 


3.2 


11.19 


7.99 


.66 




.126 


.07 


...do... 


1. 0309 


4.0 


12.72 


8.72 


.69 




.149 


.07 


...do... 


1. 0308 


4.6 


13.49 


8.89 


.65 




.157 


Trace. 


...do... 


1. 0309 


4.9 


13.75 


8.85 


.70 




.139 


Trace. 


Aug. 30 


1.031 


4.6 


13.24 


8.64 


.72 




.156 


.07 


...do... 


1. 0294 


4.5 


12. 47 


7.97 


.66 




.125 


.07 


...do... 


1. 0315 


4.2 


12.74 


8.54 


.70 




.129 


.33 


...do... 


1.033 


4.2 


12.03 


7.83 


.68 




.149 


Trace. 


...do... 


1.030 


3.0 


11.87 


' 8.87 


.67 




.131 


.13 


...do... 


1. 0319 


3.8 


12.47 


8.67 


.69 




.135 


.07 


...do... 


1. 0334 


4.0 


13.20 


9.20 


.72 




.158 


Trace. 



Re- 

fracto- 

meter 

reading. 



182B.. 
183B.. 
184B.. 
185B.. 
186B.. 
187B.. 
188B.. 
189B.. 
190B.. 
191B.. 
192Ba.. 
193B... 
194B... 
195B... 
196B&.. 
197B... 
198B c.. 
199B... 
200B... 
201B... 
202B... 
203Bd.. 
204B... 
205B... 
206B.. 
207B . . . 
208B... 
209B... 
210B... 
211B... 
212B... 
213B... 
214B... 
215B «.. 
216B<*.. 
217B... 
218B... 
219B... 
220B/.. 
221B... 
222B... 
223B... 
224B... 
225B.. 
226B.. 
227B.. 
228B.. 
229B.. 
230B-. 
231B.. 
232B.. 



a Traces of bcric acid. 

b Dirty bottle and pieces of leaves. 



c Contained hair. 
d Dirty bottle. 



« Contained straw. 
/ Straw. 



411 



Table I. — Analyses of milk sold in Washington and the District of Columbia — Cont'd. 



No. of 
sam- 
ple. 



Date. 


Specific 
gravity. 


Fat. 


Total 
solids. 


Solids 
not fat. 


1907. 










Aug. 30 


1.030 


5.0 


13.28 


8.28 


Sept. 3 


1.0323 


3.5 


12.27 


8.77 


....do... 


1. 0323 


4.1 


12.99 


8.89 


....do... 


1.0317 


4.5 


13.32 


8.82 


....do... 


1. 0308 


5.0 


13.70 


8.70 


....do... 


1. 0327 


4.4 


13.45 


9.05 


....do... 


1.0317 


4.9 


13.95 


9.05 


....do... 


1.0311 


4.4 


13.05 


8.65 


....do... 


1.0313 


4.2 


12.86 


8.66 


Sept. 4 


1. 0305 


4.7 


13.26 


8.56 


....do... 


1.0309 


4.1 


12.64 


8.54 


....do... 


1.032 


4.0 


13.05 


9.05 


....do... 


1. 0327 


4.2 


13.21 


9.01 


....do... 


1.033 


5.2 


14.39 


9.19 


....do... 


1-0315 


3.6 


12.19 


8.59 


....do... 


1.031 


3.5 


11.95 


8.45 


....do... 


1. 0327 


3.8 


12.74 


8.94 


Sept. 5 


1.0281 


3.8 


11.60 


7.80 


....do... 


1.0334 


4.0 


13.15 


9.15 


....do... 


1.029 


3.4 


11.33 


7.93 


....do... 


1.032 


3.8 


12.68 


8.88 


....do... 


1.032 


4.4 


13.40 


9.00 


....do... 


1.033 


4.8 


13.91 


9.11 


....do... 


1.031 


3.4 


11.83 


8.43 


....do... 


1.028 


3.8 


11.35 


7.55 


Sept. 6 


1.032 


3.6 


12.44 


8.84 


....do... 


1. 0325 


4.3 


13.41 


9.11 


....do... 


1. 0295 


3.4 


11.40 


8.00 


....do... 


1.0314 


4.6 


13.37 


8.77 


....do... 


1. 0326 


3.6 


12.47 


8.87 


....do... 


1. 0296 


3.9 


12.08 


8.18 


....do... 


1.0315 


4.1 


12.80 


8.70 


....do... 


1.031 


4.6 


13.27 


8.67 


Sept. 9 


1. 0323 


3.8 


12.73 


8.93 


....do... 


1.033 


3.8 


12.81 


9.01 


....do... 


1. 0335 


3.9 


13.05 


9.15 


....do... 


1. 0276 


3.6 


11.36 


7.76 


....do... 


1.032 


3.6 


12.32 


8.72 


....do... 


1. 0329 


4.0 


13.02 


9.02 


....do... 


1.033 


3.8 


12.81 


9.01 


....do... 


1.031 


4.8 


13.51 


8.71 


Sept. 10 


1. 0334 


3.0 


11.95 


8.95 


....do... 


1. 0324 


4.0 


12.90 


8.90 


....do... 


1.0325 


4.2 


13.16 


8.96 


....do... 


1. 0316 


3.5 


12.10 


8.60 


....do... 


1.0305 


3.6 


11.94 


8.34 


....do... 


1.031 


4.4 


12.55 


8.15 


....do... 


1.0333 


3.2 


12.16 


8.96 


Sept. 11 


1. 0334 


3.6 


12.57 


8.97 


....do... 


1.0325 


4.2 


13.19 


8.99 


....do... 


1.0308 


3.2 


11.77 


8.57 


....do... 


1.0323 


3.5 


12.27 


8.77 



Ash. 



Milk 
sugar. 



Acidity. 



Sedi- 
ment. 



Re- 

fracto- 

meter 

reading. 



233B . . 

234B . . 

235Ba. 

236B... 

237Bo.. 

238B... 

239B... 

240Ba.. 

241Ba.. 

242B . . . 

243B... 

244B... 

245B... 

246B... 

247B... 

248B... 

249B... 

251B... 

252B b . 

253B... 

254B... 

255B... 

256B... 

257B... 

258B... 

259B... 

260B... 

261B... 

262B... 

263B... 

264B... 

265B... 

266B... 

267B... 

268B... 

269B... 

270B... 

271B... 

272B... 

273B... 

274B.. 

275B... 

276B.. 

277B . . 

278B . . 

279B . . 

280Bc 

281B.. 

285B . . 

286B . . 

287B.. 

288B.. 



,62 



.50 



654 



132 
198 



.148 
.173 
.171 
.157 
.162 
.162 
.167 
.164 
.155 
.155 



a Stale milk in bottle. 



Dead fly. 



.178 
.135 
.173 
.135 
.162 
.228 
.144 
.140 
.124 
.162 
.142 
.142 
.135 
.144 
.136 
.128 
.140 
.153 
.178 
.148 
.131 
.141 
.149 
.160 
.149 
.164 
.157 
.409 
.151 
.139 
.146 
.149 
.164 
.160 
.142 
.180 
c Stale milk in 



Trace. 

.07 

Trace. 



.07 
.07 

Trace. 
.13 
.20 
.07 

Trace. 

Trace. 



.13 

.07 
. .07 
Trace. 
Trace. 

.07 

.07 
Trace. 
Trace. 

.07 
Trace. 

.13 
Trace. 

.60 

.13 
None. 

.07 
None. 
None. 

.13 

.20 

.13 
Trace. 
Trace. 

.07 
Trace. 
Trace. 

.07 
None. 

.07 
Trace. 
Trace. 
None. 
Trace. 

.07 
None. 
Trace. 
Trace. 
None, 
bottle. 



412 



Table I. — Analyses of milk sold in Washington and the District of Columbia — Cont'd. 



No. of 
sam- 
ple. 



Date. 



Specific 
gravity. 



Fat. 



Total 
solids. 



Solids 
not fat. 



Ash. 



Milk 
sugar. 



Acidity. 



Sedi- 
ment. 



Re- 
fracto- 
meter 
reading. 



289B.. 
290B.. 
291B.. 
293B.. 
294B.. 
295B . . 
296B.. 
297B a. 
298B.. 
299B.. 
300B.. 
301B.. 
303B.. 
304B.. 
305B.. 
306B.. 
307B.. 
308B.. 
309B.. 
310B . . 
311B.. 
312B.. 
313B.. 
314B.. 
315B.. 
316B.. 
317B.. 
318B.. 
lO... 
2Ca... 
3C... 
4C... 
5C... 
6C... 
7C... 
80 .. 
9C... 
IOC... 
11C... 
12C . . . 
13C . . . 
14C . . . 
15C . . . 
16C . . . 
18C . . . 
20C . . . 
21C . . . 
22C . . . 
23C . . . 
24C... 
25C... 
26C... 



1907. 

Sept. 11 
....do... 
....do... 
....do... 

Sept. 12 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 

Sept. 13 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 

Sept. 16 
....do... 

Sept. 16 
....do... 
....do... 
....do... 
....do... 
....do... 

Sept. 18 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 

Sept. 19 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 

Sept. 20 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 
....do... 



1. 0325 
1. 0271 

1. 0327 
1.0325 
1.033 
1. 0298 
1. 0325 
1.032 
1.0276 
1. 0275 
1.032 
1.029 
1.0325 
1.0321 
1.0311 
1.0317 

1. 0328 
1. 0279 
1.030 
1.030 
1.026 
1.031 
1.026 
1.035 
1. 0336 
1.030 
1.031 
1. 0321 
1.031 
1.0291 
1. 0281 
1. 0293 
1. 0319 
1. 0314 
1. 0308 
1.0333 
1.027 
1.0312 
1. 0298 
1.0246 
1.0296 
1.032 
1. 0295 
1. 0308 
1. 0269 
1.0319 
1.0304 
1. 0264 
1.0275 
1.0327 
1. 0307 
1.0244 



4.4 
3.0 
3.6 
4.6 
3.2 
3.5 
3.7 
4.4 
5.8 
4.0 
3.8 
3.6 
4.4 
4.0 
4.2 
3.7 
4.2 
4.8 
4.4 
3.8 
8.9 
3.8 
3.2 
2.6 
3.5 
4.2 
4.5 
5.0 
4.6 
3.8 
3.6 
5.0 
3.8 
4.4 
4.8 
3.7 
3.8 
4.7 
4.1 
3.5 
3.5 
4.1 
4.2 
5.6 
4.8 
3.5 
5.0 
3.3 
4.6 
3.8 
4.4 
3.6 



13.40 
10.92 
12.49 
13 ; 64 
12.09 
11.65 
12.56 
13.28 
13.86 
11.67 
12.56 
11.57 
13.40 
13.05 
12.81 
12.35 
13.24 
12.73 
12.78 
12.06 
17.18 
12.31 
10.21 
11.87 
12.60 
12.54 
13.15 
14.02 
13.27 
11.83 
11.34 
13.31 
12.54 
13.18 
13.46 
12.76 
11.48 
13.45 
12.37 
10.31 
11.60 
12.92 
12.32 
14.42 
12.66 
12.18 
13.60 
10.94 
12.40 
12.74 
12.96 
10.44 

a Stale 



9.00 
7.92 
8.89 
9.04 
8.89 
8.15 



8.06 
7.67 
8.76 
7.97 
9.00 
9.05 
8.61 
8.65 
9.04 
7.93 
8.38 
8.26 
8.28 
8.51 
7.01 
9.27 
9.10 
8.34 
8.65 
9.02 
8.67 
8.03 
7.74 
8.31 
8.74 
8.78 
8.66 
9.06 
7.68 
8.75 
8.27 
6.81 
8.10 
8.82 
8.12 
8.82 
7.86 
8.68 
8.60 
7.64 
7.80 
8.94 
8.56 
6.84 



514 



,04 



52 



146 
133 
148 
162 
144 
122 
139 
144 
142 
131 
147 
,136 
,129 
,157 
,148 
,149 
.151 
,128 
,151 
.157 
.144 
.139 
.119 
.115 
.167 
.137 
.135 
.160 
.149 
.122 
.122 
.113 
.175 
.135 
.131 
.166 
.115 
.133 
.140 
.104 
.130 
.149 
.139 
.126 
.137 
.146 
.181 
.124 
.131 
.158 
.142 
.099 



Trace. 
.07 
.07 

Trace. 

Trace. 
.13 
.07 
.07 

None. 
.07 

Trace. 

Trace. 

Trace. 
.13 

None. 

Trace. 

Trace. 

None. 

None. 
.07 

Trace. 

Trace. 
.07 
.07 
.07 
.07 
.13 

None. 
.07 
.07 

Trace. 
.13 

Trace. 
.07 

Trace. 

Trace. 
.07 
.07 
.07 
.07 
.07 

Trace. 
.07 
.13 
.07 
.07 
.07 

Trace. 

Trace. 

Trace. 

Trace. 

Trace. 



milk in bottle. 



413 



Table I. — Analyses of milk sold in Washington and the District of Columbia — Cont'd. 



Date. 


Specific 
gravity. 


Fat. 


Total 
solids. 


Solids 
not fat. 


1907. 










Sept. 23 


1.031 


3.4 


11.84 


8.44 


....do... 
....do... 
....do... 
....do... 


1. 0314 
1. 0323 
1.0298 
1.0257 


3.6 
4.0 
5.2 
3.2 


12.18 
12.88 
13.69 
10.28 


8.58 
8.88 
8.49 
7.08 


....do... 


1.0315 


4.8 


1418 


9.38 


....do... 


1. 0347 


4.4 


14.46 


10.06 


....do... 


1.032 


4.2 


11.84 


7.64 


Sept. 24 


1.0315 


4.2 


12.92 


8.72 


....do... 


1. 0319 


3.8 


12.54 


8.74 


....do... 


1.0309 


4.7 


13.37 


8.67 


....do... 


1.0349 


3.9 


13.41 


9.51 


....do... 


1. 0319 


4.3 


13.14 


8.84 


....do... 


1. 0284 


5.4 


13.58 


8.18 


....do... 


1. 0327 


3.5 


12.38 


8.88 


....do... 


1.032 


3.6 


12.32 


8.72 


Sept. 25 


1.033 


4.2 


13.29 


9.09 


....do... 


1. 0313 


4.2 


12.87 


8.67 


....do... 


1. 0336 


4.6 


13.92 


9.32 


....do... 


1. 0274 


4.1 


11.77 


7.67 


....do... 


1.0309 


4.2 


12.77 


8.57 


....do... 


1. 0317 


4.5 


13.33 


8.83 


....do... 


1.0297 


4.7 


13.07 


8.37 


....do... 


1.033 


4.8 


14.01 


9.21 


Sept. 26 


1.0327 


4.2 


13.22 


9.02 


....do... 


1. 0318 


4.0 


12.75 


8.75 


....do... 


1.0295 


4.0 


12.18 


8.18 


....do... 


1. 0304 


4.4 


12.88 


8.48 


....do... 


1.0288 


3.1 


10.93 


7.83 


....do... 


1. 0334 


47 


13.99 


9.29 


....do... 


1. 0303 


4.9 


13.46 


8.56 


....do... 


1.0303 


3.8 


12.15 


8.35 


Sept. 27 


1. 0329 


5.0 


14.23 


9.23 


....do... 


1.0334 


4.5 


13.76 


9.26 


....do... 


1.0314 


46 


13.38 


8.78 


....do... 


1.0334 


4.2 


13.39 


9.19 


....do... 


1.033 


4.0 


13.06 


9.06 


....do... 


1.032 


4.4 


13.28 


8.88 


....do... 


1.031 


4.9 


13.64 


8.74 


....do... 


1. 0321 


6.3 


15.59 


9.29 



Ash. 



Milk 
sugar. 



Acidity. 



.142 
.171 
.129 
.146 
.120 
.165 
.165 
.151 
.146 
.158 
.128 
.212 
.151 
.166 
.157 
.178 
.155 
.151 
.157 
.124 
.158 
.149 
.128 
.155 
.160 
.158 
.140 
.137 
.124 
.153 
.128 
.144 
.157 
.175 
.140 
.175 
.160 
.171 
.131 
.167 



Sedi- 
ment. 



Trace. 
.07 
.07 



Trace. 
.07 
.07 

Trace. 

Trace. 



.07 
None. 

.07 
None. 
None. 
Trace. 

.07 
Trace. 
None. 
None. 
Trace. 
None. 

.07 
None. 
Trace. 
Trace. 
None. 

.07 
Trace. 
None. 

.07 

.07 
Trace. 

.07 

.13 
Trace. 
Trace. 
None. 

.07 
Trace. 



Re- 

fracto- 

meter 

reading. 



o Stale milk in bottle. 



414 



Table II. — Showing Washington milks below standard, and those containing dirt, as 
previously reported to the health department. 

[The sample-numbers are those assigned by the D. C. Health Office. Each particular group of num- 
bers represents all of the samples examined from any particular dairy.] 



Sample numbers (D. C. health 
office) of milks examined. 



Total 
num- 
ber of 
milks 
exam- 
ined. 



Milks found below- 
standard. 



Total 
num- 
ber of 
milks 
below- 
stand- 
ard. 



Milks containing dirt. 



Total 
num- 
ber of 
milks 

con- 
taining 

dirt. 



27 A, 80 A, 74 B, 159 B, 36 C, 14 B. . 

50 A, 233 B, 264 B 

72 A, 37 B, 200 B, 62 C, 317 B 

57 B, 208 B, 315 B 

33A,95B 

29A,198B 

9 B, 32 B, 178 B, 246 B, 267 B, 60 C. 
42C 

41 A, 68 A, 25 B, 111 B, 161 B, 253 B, 
265 B, 273 B, 301 B, 309 B. 

84B 

38 A, 84 A, 127 B, 210 B, 15 C, 54 C. . 

10 A, 101 B, 165 B, 259 B, 1 C 

63 A 

42B 

49B,87B 

53A,64B,27C 

82 A, 90 B, 190 B, 294 B, 25 C 

21 A, 81 A, 71 B, 119 B, 167 B, 217 B, 

224 B, 231 B, 241 B, 35 C, 242 B. 
7 A, 16 B, 12 B, 73 B, 61 B, 155 B, 

277 B, 65 B, 39 C. 

91B,260B 

2 A,46C 

28A,38B 

42 A, 299 B 

11 A, 5 B, 85 B, 163 B, 41 C 

46 A, 2 B, 86 B, 185 B, 51 C 

77 A 

1 A, 58 A, 22 B, 124 B, 228 B, 303 B, 

4C. 

52B 

75A,46B,121B 

51 B, 184 B, 196 B, 293 B, 64 C 

107B 

24 B 

5 A, 64 A, 20 B, 93 B, 225 B, 312 B. . 
16 A, 81 B, 137 B, 212 B, 22 C. . . 
13 A, 83 A, 89 B, 149 B, 263 B, 24 C. 

12 A, 67 A,180B 

76 A, 50 B, 183 B, 65 C 

63 B, 164 B, 305 B, 29 C 

43B 

182B 

113 B, 306 B, 16 C, 17 B 

25A,307B 

146B,295B 



74B 

50 A 

37 B 

41 A, 68 A, 253 B 
84 B 

82 A, 294 B 

119B 

65 B, 61 B 

299 B 

24 B 

16 A, 22 C 



80 A, 14 B, 159 B 

50A 

37 B, 62 C, 317 B, 72 A. 
57B,315B 

198B 

32B,172B,267B,246B 

25 B, 41 A, 111 B, 161 
B, 253 B. 

84B 

127B,15C 

101 B, 165 B, 1C 

42B 

49B,87B 

64B,27C 

82 A, 190 B 

119 B, 167 B, 231 B, 241 

B,242B, 71 B. 
39 C, 12 B, 16 B, 73 B, 

155 B. 
91B,260B 

38B 

299 B 

85B,163B 

86B,185B . 

77 A 

124 B, 228 B, 4C 

52B 

46 B, 75 A 

184 B 

24B 

64A 

81 B, 137 B 

263B 

50 B, 183 B, 76 A 

63B 

59 C 

182B 

113 B, 16 C, 17 B 

146B,295B 



415 



Table II. — Showing Washington milks below standard, and those containing dirt, as 
previously reported to the health department. — Continued. 



Sample numbers (D. C. health 
office) of milks examined. 



Total 
num- 
ber of 
milks 
exam- 
ined. 



Milks found below 
standard. 



Total 
num- 
ber of 
milks 
below 
stand- 
ard. 



Milks containing dirt. 



Total 
num- 
ber of 
milks 

con- 
taining 

dirt. 



138 B, 56 C 

23 A, 108 B, 216 B, 223 B, 232 B, 240 
B, 247 B, 252 B, 262 B, 272 B, 278 
B, 288 B, 300 B, 304 B, 11 C, 37 C. 

39 A, 78 A, 85 A, 6 B, 76 B, 94 B, 
132 B, 144 B, 256 B, 297 B. 

37 A, 29 B, 110 B, 187 B, 53 C 

44 A, 80 B, 136 B, 213 B, 21 C 

130 B, 261 B, 298 B 

57 A, 66 B, 104 B, 172 B, 230 B, 9 C, 
47 C. 

251B,18C 

98 B, 188 B, 13 C 

78 B, 145 B, 238 B 

62B,67C. 

35 A, 27 B, 152 B, 214 B 

54 A, 6C, 162 B 

106B,229B 

19 A, 48 A, 15 B, 115 B, 271 B, 
26| C. 

23 B, 117 B, 32 C 

56B,83B, 158 B, 206 B, 270 B 

17 A, 79 A, 13 B, 35 B, 92 B 

20 A, 54 B, 142 B, 218 B, 287 B, 
311 B. 

102B,275B 

36B,204B 

280B,44C 

139B,291B 

128B,55C 

105 B, 168 B, 7 C, 49 C 

24 A, 26 B, 192 B, 313 B, 26 C, 30 C. 

44B,220B 

40 A, 40 B, 140 B, 243 B, 61 C 

9 A, 52 A, 4 B, 100 B, 166 B, 202 B, 

237 B. 

191B,314B 

8A,11B 

103B,276B 

43 A, 79 B, 221 B, 58 C 

31C 

47 A, 99 B, 179 B, 8 C, 38 C 

55 B 

26 A, 61 A, 18 B, 34 B, 59 B, 116 B, 

193 B, 45 C. 

32 A, 97 B, 154 B, 269 B 

75B,157B 



138 B, 56 C 

108 B 

78A , 

261B 

57 A, 230 B, 9 C. 

251B 

106 B 

48A,26iC 

56 B 

79 A 

287B 

275B 

24 A, 30 C, 313 B 
26 C. 

52 A 

314B 

99B 



240 B, 247 B, 252 B, 
108 B, 216 B, 11 C, 
223 B, 304 B, 37 C. 

78 A, 85 A, 76 B, 94 B, 
132 B, 144 B, 56 B, 
297 B. 

187 B,37 A 

80 B, 136B,21C, 44 A. 

130B,261B 

104 B, 172 B, 230 B, 
9 C, 57 A. 

18C 

188B,13C 

238B 



35 A, 152 B, 214 B 

6 C, 54 A, 162 B 

106B 

115 B, 271 B, 19 A, 
48 A. 

23 B, 117B,32C 

83 B, 158 B, 206 B 

79 A, 13 B, 35 B, 92 B 
54 B, 218 B 



36B,204B.. 

44 C 

139 B, 291 B. 
128 B, 55 C. 



26 B, 192 B, 313 B, 

24 A. 

44B,220B 

40 B, 61 C, 40 A 

4 B, 100 B, 166 B, 202 

B, 237 B. 
191B.314B 



103 B, 276 B 

79 B, 58 C, 43 A. 

31C 

99 B, 47 A 

55 B 

34B.59B 



154 B, 32 A. 



416 

Table II. — Showing Washington milks beloiv standard, and those containing dirt, as 
previously reported to the health department — Continued. 



Sample numbers (D. C. health 
office) of milks examined. 



18 A, 33 B, 150 B, 268 B. 



Total 
num- 
ber of 
milks 
exam- 
ined. 



59 A, 114 B, 169 B, 227 B, 308 B, 2 C. 



49A,148B 

147B,289B 

133B,281B 

134 B, 234 B 

36 A, 28 B, 112 B, 186 B, 219 B, 285 

B, 14 C. 

235B 

69 A 

41 B 

60 A, 70 B, 205 B, 245 B, 40 C 

15 A, 129 B, 211 B 

30 A, 53 B, 197 B, 63 C 

58 B, 156 B, 209 B 

27 A, 51 A, 39 B, 153 B, 199 B, 52 C. 
7 B, 131 B, 215 B, 222 B, 239 B, 248 

B, 257 B, 274 B, 290 B, 296 B, 

310 B. 

181B 

3 A, 74 A , 

14 A, 30 B, 82 B, 135 B, 189 B, 12 C, 

23 C. 

3 B, 174 B, 254 B, 279 B, 3 C 

34 A, 96 B, 141 B 

55 A,69B 

IB 



70 A, 72 B, 88 B, 120 B, 194 B, 258 B. 

316 B, 66 C, 15 A. 
31 A, 71 A, 8 B, 122 B, 195 B, 249 B, 

28 C. 

236 B 

66 A, 77 B, 176 B, 266 B, 20 C 

68 B, 123 B, 173 B, 5 C 

62 A, 10 B, 60 B, 126 B, 50 C 

6 A 65 A, 19 B, 109 B, 160 B, 33 C 

4A,21B,203B 

56 A, 67 B, 171 B, 207 B, 226 B, 

244 B, 286 B, 48 C 

57C 

45 A, 73 A, 175 B, 201 B, 255 B, 

318 B, 10 C. 

Totals 



Milks found below 
standard. 



18 A, 33 B. 



281 B. 
219 B. 



222 B, 257 B, 290 B 



30 B, 12 C. 



3B. 



55 A. 
258 B. 

31 A. 



173 B. 



Total 
num- 
ber of 
milks 
below- 
stand- 
ard. 



55 



Milks containing dirt. 



268 B, 150 B, 33 B, 

18 A. 
114 B, 169 B, 227 B, 2 

C, 59 A. 

147B 

281B 

134 B, 234 B 

28 B, 112 B, 219 B.... 

69 A 

70B,205B 

211 B 

197 B, 30 A 

156B,209B 

153 B, 51 A 

7 B, 131 B, 215 B, 222 
B,248 B, 274 B, 290 
B, 296 B, 310 B. 

181 B 

82 B, 135B,189B,12C. 

3B,174B 

96B 

55 A 

88 B, 194 B, 258 B, 316 

B, 66 C, 70 A. 
195B,28C, 71 A 

266B,20C,66A 

123 B, 173 B 

50C 

19 B, 109 B, 160 B, 65 A 
21 B, 203 B 

67 B, 171 B, 207 B, 226 
B, 56 A. 

201 B, 10C, 73 A 



REFERENCES TO THE LITERATURE. 



PART I.— THE COMPOSITION AND GENERAL CHARACTERISTICS OF 

MILK. 

(1) Beckmann, Milch-Zeit, 23, 702-703. 

(2) Atkins, Chem. News, 97, 1908, 241-242. 

(3) Koppe, Jahrb. f. Kinderheilk., 1898, 47, 389. 

(4) Fleischmarm, Jour. f. Landw., 1902, 50, 33. 

(5) Fleischmann. (See Raudnitz, Ergebniss d. Physiol., Abt. 1, 1903, p. 299.) 

(6) SoxMet, ibid., p. 300. 

(7) Conn, Zur Morphologie der Milch, Virchow's Archiv, 1900, 162, 187 to 206 

and 406 to 443. 

(8) Savage, Jour. Hygiene, 1906, 6, 123-138. 

(9) Leach, Food Inspection and Analysis, New York, 1907, p. 119. 

(10) Richmond, Analyst, 1900, 25, p. 121. 

(11) Vogel, Jour. Prakt. Chem. [2], 8, 137-144. 

(12) Halliburton, J. Physiol. (London), 1890, 11, 448^63. 

(13) Burow, Zeit. f. Physiol. Chem., 1900, 30, 495-507. 
Bordas and Raczkowski, Compt. Rend., 1902, 135, 354-355. 
Koch, Zeit. f. Physiol. Chem., 1906, 47, 327-330. 

(14) Siegfeld, Milch w. Zentr., 1906, 2, 1-5. 

(15) Uinikoff, Zeit. f. Physiol. Chem., 1900, 30, 101. (See Sieber.) 
Sieber, ibid., p. 101-112. 

Vaudin, J. Pharm., 1894, [5], 30, 464^66. 
Obermaier, Arch. Hyg, 1904, 50, 52-65. 

(16) Landolf, Biochem. Zeitschr., 1907, 4, 172-195. 

(17) Biscaro and Bolloni, Mon. Scient., (4), 19, I., 384. 

(18) Sherman, Berg, Cohen and Whitman, J. Biol. Chem., 1907, 3, 171-175. 

(19) Trillat and Sauton, Compt. Rend., 1905, 140, 1266-1268. 

(20) Schondorf, Pfltiger's Archiv, 1900, 81, 42^7. 

(21) Jolles, Arch. Exp. Path. Pharm., 1901, 46, 247-260. 

(22) Camerer, Zeit. Biol., 1905, 46, 371. 

(23) Jolles and Friedjung, Arch. Exp. Path. Pharm., 1901, 46, 247. 

(24) Van der Marck, Pharm. Weekblad, 1907, 44, 153-155. 

(25) Desmoulieres and Gautrelet, Comptes rend. Soc. Biol., 1903, 55, 632-633. 

(26) Bordas and Touplain, Compt. rend., 1906, 142, 1204-1205. 
(2J) Dombrowski, Arch. Hygien, 1904, 50, 183-191. 

(28) Rosemann, Pfluger's Archiv., 1900, 78, 466-504. 

(29) Teichert, Bied. Centr., 1902, 31, 210. 

(30) Bechamp, Compt. rend., 94, 1533-1536. 

(31) Golding and Feilmann, Jour. Soc. Chem. Ind., 1905, 24, 1285-1286. 

(32) Marfan and Gillet, Monatsschr. f. Kinderheilk., 1902, 1, 57-64. 

(33) Woodhead and Mitchell, Jour, of Path, and Bact, 1907, 11, 408-414. 

45276°— Bull. 56—12 27 (417) 



418 

(34) Briefer, Zeitsch. f. Hygien, 1893, 13, 336; and ibid., 1893, 15, 439. 

(35) Van Slyke, Modern Methods of Testing Milk and Milk Products, New York 

and London, 1907, p. 15. 

(36) See " Food Inspection and Analysis," by Albert E. Leach, New York, 1907. 

p. 90. 

(37) U. S. Department of Agriculture, Farmer's Bulletin No. 29, 1895. 

(38) Van Slyke, loc. cit., p. 15. 

(39) Leach, loc. cit., p. 91. 

(40) Bunge, Pathologic and Physiologic Chemistry, by G. Bunge, 2d English ed., 

tr. by Florence A. Starling, 1902, 104-105. 

(41) Richmond, Analyst, 1901, 26, 310-316 ; ibid., 27, 240-243 ; ibid., 29, 180-187 ; 

ibid., 30, 325-329; ibid., 31, 176-180. 

(42) Richmond, ibid., 31, 176-180. 

(43) Billitz, Milchw. Zentr., 1905, 1, 113-132. 

(44) Cook and Hills, Vermont Exp. Stat. Rep., 1891. 

(45) Wanters, Rev. Interv. Falsific, 1902, 15, 67-69. 

(46) Janke, Bied. Centr., 1880, 899-905. 

(47) Janke, ibid., 1879, 929. 

(48) Richmond, Analyst, 1902. 

(49) Sherman, Jour. Amer. Chem. Soc, 1903, 25, 132-142. 

(50) Richmond, Analyst, 1904, 29, 180-187; ibid., 31, 176-180. 

(51) Albert and Maercker, Landw. Jahrb., 1898, 27. 

(52) Rhodin, K. Land. Akad. Handl., 1888, 37, 25. 

(53) Bartlet, 14th Ann. Rep. Maine Agr. Exp. Stat., 1898, 114-117. 

(54) Gogitidse, Zeit. Biol., 1904, 45, 365. 

(55) Hills, 12th Ann. Rep. Vermont Agr. Exp. Stat., 1898-99, 269-275. 

(56) V. Henriques and Hansen, Exp. Stat. Record, 1900, 11, 674-676. 

(57) Sebelien, Landw. Versuchs Stat., 1895, 46, 259-308. 

(58) Wing, Ann. Agronom., 1896, 22, 94-95. 

(59) Morgen, Beger, Fingerling, Doll, Hancke, Sieglin, and Zielstorff, Landw. 

Versuchs Stat., 1904, 61, 1-284. 

(60) Morgen, Beger and Fingerling, ibid., 1906, 64, 93-242. 

(61) Fingerling, ibid., 1906, 64, 299^12. 

(62) Fingerling, ibid., 1905, 62, 11-180. 

(63) Temesvary, Centr. f. Med. Wissenschft, 1900, 38, 668. 

(64) Morgen, Beger and Fingerling, loc. cit., 1905, 62, 251-386. 

(65) Caspari, Archiv. Anat. u. Physiol., 1899, suppl., 267-280. 

(66) Caspari, Zeit. Biol., 46, 277-279. (See also Zeit. Biol. 1907, 49, 558-561.) 

(67) Einecke, Bied. Centr., 1904, 33, 239-245. (See also Gogitidse, Zeit. Biol. 

1906, 47, 475-486.) 

(68) Malmejac, J. Pharm., 1901, [VI] 14, 70-74. 

(69) Woll, Report Wis. Agr. Exp. Stat., 1891, 49-60. 

(70) Pfeiffer, Einecke and Schneider, Mitt. Landw. Inst. K. Univ. Breslau, 1905, 

3, 179-225. 

(71) Morgen, Beger and Westhauser, Landw. Versuchs Stat., 1907, 65, 413-440. 

(72) Trunz, Zeit. f. Physiol. Chem., 1903, 39, 380-395. 

(73) Trunz, ibid., 1903, 40, 263-310. 

(74) Hardy, Bull. Assoc. Beige Chim., 1901, 15, 228-229. 

(75) Ackermann, Milch Zeit., 1902, 31, 166-168. 

(76) Hills, 12th Ann. Rep. Vermont Agr. Exp. Stat, 1898-1899, 309. 

(77) Dornic, Milch Zeit., 1896, 331. 

(78) Moerman, Bull. Assoc. Beige Chim., 16, 147-151. 

(79) Lawrence; Boston Med. and Surg. Journ., Vol. 161, 1909, p. 152. 



419 

PART II.— (1) CHANGES IN THE COMPOSITION OF MILK PRODUCED 
BY THE ACTION OF HEAT AND ACIDS, AND EFFECT OF HEAT ON 
ENZYMES. 



(1 
(2 
(3 
(4 
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(7 
(8 
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(12 
(13 
(14 
(15 
(16 
(17 
(18 
(19 
(20 
(21 
(22 
(23 
(24 
(25 
(26 
(27 
(28 
(29 
(30 
(31 
(32 
(33 
(34 
(35 
(36 
(37 
(38 
(39 
(40 
(41 
(42 
(43 
(44 
(45 
(46 
(47 
(48 
(49 



Thorner, Cliem. Zeit., 1891, 1108. 
Richmond, Analyst, 1900, 25, 121. 
Stokes, Analyst, 16, 122. 

Jamison and Hertz, J. Physiol., 1901, 27, 26-30. 
Rettger, Amer. J. Physiol., 1902, 7, 325^330. 
Harris, J. Anat. and Physiol., 1894, 29, 188-200. 
Rettger, Amer. J. Physiol., 1902, 6, 450^57. 
Franz Utz, Milch Zeit., 1903, 32, 354-355. 
Wassermann and Schiitze, Zeitschr. f. Hygien, 1901, 36. 
P. T. Miiller, Archiv. f. Hygien, 1902, 44, 136-137. 
Cazeneuve and Haddon, Compt. rend., 1895, 120, 1272-1273. 
Bruno Bardach, Monatshefte, 1897, 18, 199-216. 
Loevenhart, Zeit. f. Physiol. Chem., 1904, 41, 189-190. 
Yon Soxhlet, Verh v Ges. deut. Naturforsch. Aerzte, 1904, II, 151-152. 
Thorner, same as (1). 
Rideal, Lancet, 1900, I, p. 229. 
Revis and Payne, J. Hygiene, 7, 1907, 216-231. 
Pasteur, Studies on Fermentation, 1879, p. 34. 

Babcock and Russell, Centr. f. Bakt. u. Par. 1900, Abt. 2, 6, 17-22, 79-88. 
Fermi, Archiv. f. Hygien, 14, 1892, p. 19. 
Wender, Oesterr. Chem. Zeit., 6, 1-3. 

Yon Freudenreich, Centr. f. Bakt. u. Par., 1900, Abt. 2, 6, 332-338. 
Hippius, Jahrb. f. Kinderh., 1905, II, 365. 

Gillet, Journ. d. Physiol, et d. Pathol. Generate, 1903, 3, 503-518. 
Hougardy, Bull. Acad. Roy. Belg., 1906, 1888-1900. 
Zelinski, Jahrb. f. Kinderh., 1906, 63, 288-307. 
Schardinger, Zeit. Nahr. Genussm., 1902, 5, 1113-1121. 
Glage, Zeit. Fleisch. u. Milch-Hygien, 1901, 11, 162. 
Franz Utz, Pharm. Central Halle, 1901, 42-149. 
Schaffer, Schweiz. Woch. Pharm., 38, 15. 
Rullmann, Zeit. Nahr. Genussm., 1904, Heft 2. 
Y. Storch, Bied. Centr., 1898, 27, 711-714. 
Freeman, Proc. N. Y. Path. Soc, 1897-1898, p. 222. 
Du Roi and Koehler, Milch Zeit., 1902, 31, 17-18 ; and 113. 
Weber, ibid., 1902, 31, 657-659 ; and 673-676. 
Arnold and Mentzel, ibid., 1902, 31, 247. 
• Franz Utz, Chem. Zeit., 1906, 26, 1121-1122. 
Rullmann, Zeit. Nahr. Genussm., 1904, 7, 81-89. 
Yan Itallie, Pharm. Weekblad., 40, 1103-1104. 
Bruere, <J. Pharm. Chiin., 1906, [VI], 24, 488-493. 
Dupouy, These Bordeaux, 1898-1899, 80-85, No. 91. 
Douglas, Lancet, 1903, II, 23. 

Marfan and Gillet, Monatsschr. f. Kinderh., 1902, I, 57-64. 
Macadie, Pharm. J. 1907, 207. 

Wilkinson and Peters, Zeit. Nahr. u. Genussm., 16, 1908, 172-175. 
Portier, Compt. rend. Soc. Biol., 1898, 27, 453. 
Kastle and Porch. Jour. Biol. Chem., IY, 1908, 301-320. 
Yan Itallie, Proc. K. Akad. Wetensch. Amsterdam, 1906, 8, 628-630. 
Jolles, Zeit. Biol., 1903, 45, 248-260, 



420 

(50) Behring, Therapie der Gegenwart, 1904, No. 1. 

(51) Lane-Claypon, J. Pathol. Bacterid., 13, 1908, 34-37. 

(52) Raudnitz, Ergebnisse der Physiologie, 1903, Abt. 1, 322. 

(53) Tjaden, Koske and Hertel, Arb. Kais. Gesundheitsamt, 1901, 18, 219. 

(54) Weber, Zeit. f. Tiermed., 1902, 6, 419. 

(55) Kerr, Brit. Med. Jour., 1895, 52, 1491. 

(56) Halliburton, ibid., 1900, II, p. i. 

(57) Rubner, Hyg. Rundschau, 1895, No. 22, 1021-1022. 

(58) Middleton, ibid, 1901, XI, 601. 

(59) De Jager, Centr. f. Med. Wissenschaft, 1906, No. 9, p. 145. 

(60) Lorcher, Pfliig. Archiv., 1897, 99. 

(61) Forbes-Ross, Lancet, 1904, 979-980. 

(62) Green, The Soluble Ferments, Cambridge, 1899. 

(63) Oppenheimer, Die Fermente, Leipzig, 1900. 

(64) P. T. Miiller, Archiv. f. Hygien, 1902, 44, 132-133. 

(65) Kastle, Science, 1901, 765-771. 

(66) Marfan, La Presse Medicale, Paris, 1901, p. 13-16. 

(67) Bokorny, Chem. Zeit., 1900, Dec, and Pfliig. Archiv., 1901, 85, 257-270. 

PART II.— (2) CHANGES IN THE COMPOSITION OF MILK BROUGHT 
ABOUT BY THE MILK ENZYMES. 

(1) Marfan, La Presse Medicale, Paris, 1901, p. 13-16. (See also Marfan and 
Gillet, Monatschr. f. Kinderheilk., 1902, 1, 57-64.) 



(2 
(3 
(4 
(5 
(6 
(7 

(8 
(9 
(10 
(11 
(12 
(13 
(14 
(15 
(16 
(17 
(18 
(19 
(20 
(21 
(22 
(23 
(24 
(25 
(26 
(27 
(28 
(29 
(30 



P. T. Miiller, Archiv f. Hygien, 1902, 44, 126-188. 

Moro, Wien. Klin. Wochenschr., 15, 121-122. 

Engel, Deut. Aerzte Zeit., 1903, 5, 79-80. 

Moro, Jahrb. f. Kinderheilk., n. F., 1898, 47, 342-^361. 

Bechamp, Compt. rend., 96, 1508-1509. 

Van der Velde and Landtsheer, Archiv de Medicin des Enfants, 1903, 6, 

408-412. 
Babcock and Russell, Centr. f. Bakt. u. Par., Abt. 2, 1900, 6, 17-22, 79-88. 
Von Freudenreich, ibid., 332-338. 

Tice and Sherman, J. Amer. Chem. Soc, 1906, 28, 189-194. 
Wender, Oesterr. Chem. Zeit., 6, 13. 
Snyder, Bull. 74, Minn. Agr. Exp. Stat. 
Hougardy, Bull. Acad. Roy. Belg., 1906, 888-900. 
Marfan and Gillet, same as (1). 

Gillet, J. de Physiol, et d. Path, generale, 1903, 3, 513-518. 
Rogers, Centr. Bakt. u. Par., XII, 597-601. 

Nobecourt and Merklen, Compt. rend. Soc. Biol., 1901, 53, 148-149. 
Desmoulieres, J. Pharm. Chim., 1903 (VI), 17, 232-239. 
Miele and Willem, Compt. rend., 1903, 137, 135-137. 
Jolles, Zeit. Biol., 1903, 45, 248-260. 
Von der Velden, Biochem. Zeitschr., 1907, 3, 403^12. 
Amberg, J. Biol. Chem., 1, 219-228. 

Van Itallie, Proc. K. Akad. Wetensch., Amsterdam, 1906, 8, 622-630. 
Faitelowitz, Dissertation Heidelberg, 1904. 
Reiss, Zeit. Clin. Med., 56, 1-12. 
Loew, Rep. No. 68, U. S. Dept. Agric, 1901, 1-47. 
Bach and Chodat, Bied. Zent. f. Agric. Chem., 37, 1908, 168-177. 
Usher and Priestley, Proc. Roy. Soc, 77, 369-375. 
Erlenmeyer, Ber. d. deut. Chem. Ges., 1877, 10, 650-654. 
Usher and Priestley, Proc. Roy. Soc, 78, 318-327. 



421 

(31) Lesser, Zeit. Biol., 1906, 48, 1-18, and ibid., 1907, 49, 575-583. 

(32) Wender, Oesterr. Chein. Zeit, 6, 1-3. 

(33) Adam, J. Pharm. Chim., 1906, 23, 273-277. 

(34) V. Storch, Arbeit, a. d. Kaiserl. Gesundheitsamt, XVII, 1900, 110. 

(35) Lauterwald, Milch Zeit, 1903, 32, 241-242, 262-263. 
Adam, J. Pharm. Chim., 1906, 23, 273-277. 
Leffmann, Analyst, 1908, 23, 85-86. 

Tan Itallie, Pharm. Weekbl., 40, 1103-1104. 
Rullmann, Zeit. Nahr. Genussm., 1904, 7, 81-89. 
Franz Utz, Milch Zeit., 1903, 32, 417-418. 
Dupouy, These Bordeaux, 1898-1899, 80-85, No. 91. 

(36) Bellei, Centr. Bakt. u. Par., 1904, XII, 518. 

(37) Arnold and Mentzel, Zeit. Nahr. Genussm., 1903, 7, 548-549. 

(38) Franz Utz, Chem. Zeit., 1902, 26, 1121-1122, and Milch Zeit., 1903, 32, 

417-418. 

(39) Franz Utz, Milch Zeit., 1903, 32, 594-595. 
Bruere, J. Pharm. Chem., 1906 [VI], 24, 488-493. 

(40) Kastle and Porch, Jour. Biol. Chem., IV, 1908, 301-320. 

(41) Wilkinson and Peters, Zeit. Nahr. u. Genussm., 16, 1908, 172-175. 

(42) Seligmann, Zeit. Hygien u. Infectionskrankheiten, LII, Heft. 2. 

(43) Schardinger, Zeit. Nahr. Genussm., 1902, 5, 1113-1121. 

(44) Smidt, Hygienische Rundschau, 1904, 23, 1137-1143. 

(45) Seligmann, Zeit. Hygien., 52, 161-178, and ibid., 1907, 58, 1-13. 

(46) Cathcart, Jour. Hygien., 1906, 6, 300-303. 

PART II.— (3) CHANGES IN THE COMPOSITION OF MILK BROUGHT 
ABOUT BY THE DIGESTIVE FERMENTS. 



(1 
(2 
(3 
(4 

(5 
(6 

(7 
(8 

(9 
(10 

(11 
(12 
(13 
(14 
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(18 
(19 
(20 
(21 
(22 



THE EENNIN COAGULATION OF MILK. 

Lehmann and Hempel, Pfliiger's Archiv., 1894, 56, 558. 

Mann, Chemistry of the Proteids, Loud., 1906, p. 70. 

Cohnheim, Zeit. Physiol. Chem., 1902, 35, 134. 

Tunnicliffe, Jour. Hygiene, 1902, 2, 445-451. 

Fremy, Ann. d. Pharm. (Liebig), 1839, 31, 188-190. 

Liebig, Plimmer, Fermentations, Lond., 1903, 110. 

Soxhlet, Jour. f. Prakt. Chem., n. F., 6, 33. 

Hallier. (See Green, The Soluble Ferments and Fermentations, Cam- 
bridge, 1899, 242.) 

Heintz, Jour. f. Prakt. Chem., n. F., 6, 374-384. 

Hammarsten, Maly's Jahresb., 1872, p. 118 ; ibid., 1874, p. 135 ; ibid., 1877, 
p. 158. 

Schmidt, Beitrage zur Kenntniss der Milch, Dorpat, 1871. 

Halliburton, J. of Physiol., 1890, 11, 448-463. 

Schultze and Rose, Landw. Vers. Stat., 31. 

Loevenhart, Zeit. f. Physiol. Chem., 1904, 41, 177-205. 

Briot, Etudes sur la pressure et l'antipressure, these de Paris, 1900. 

Arthus and Pages, Archives de Physiol., 1890, 331. 

Courant, Pfliiger's Archiv., 1891, 50, 109-165. 

Ringer, J. of Physiol., 1890, 11, 464^77. 

Edmunds, J. of Physiol., 1896, 19, 466. 

Benjamin, Virchow's Archiv., 1896, 145, 30-48. 

Soldner, Landw. Versuchs. Stat., 35, 351. 

Laqueur, Biochem. Centr., 1905-1906, IV, 334. 



422 

(23) Laqueur, Biochem. Centr., 1905-1906, IV, 333-347. 

(24) Fuld, Biochein. Zeitschr. 1907, 4, 488^99. 

(25) P. T. Mtiller, Archiv. f. Hygiene, 1902, 44, 144-150. 

(26) Rotondi. (See Laqueur, loc. cit.) 

(27) Duclaux, Traite de Microbiologic, Paris, 1899, II, 291. 

(28) Arrhenius, Inimunochemistry, N. Y., 1907, 369. 

(29) Fuld, Hofmeister's Beitrage, 1902, II, 189-194. 

(30) Van Slyke and Hart, Am. Chem. Jour., 1905, 33, 461-496. 

(31) Herwerden, Zeit. Physiol. Chem., 1907, 52, 184-206. 

(32) Soldner, Dissertation, Erlangen, 1888. 

(33) Osborne, J. of Physiol., 1901, 27, p. 398. 

(34) Harris, J. of Anat. and Physiol., Lond., 1894, 29, 188. 

(35) Hammarsten and Rhodin, Maly's Jahresb., 1887, 17, 160. 

(36) Morgenroth, Centr. f. Bakt, Abt. 1, 20, 271. 

(37) Fuld and Spiro. (See Arrhenius, Immunochemistry, 1907.) 

(38) Segelke and Storch, Ugeskrift for Landman, 1870. 

(39) Loreher. (See Duclaux, loc. cit., p. 164.) 

(40) Madsen. (See Arrhenius, loc. cit, 72.) 

(41) Hillmann, Milch Zeit., 1896, 25, p. 86. 

PART II.— (4a). CHEMICAL CHANGES IN MILK PRODUCED BY BAC- 
TERIA AND VARIOUS OTHER MICRO-ORGANISMS. 



(1 

(2 
(3 

(4 
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(27 
(28 
(29 



Bechamp, Compt. rend., 94, 1533-1536. 

Blondeau. (See Plimmer, Fermentations, N. Y. and Bombay, 1903, 61.) 
Pasteur, Annales de Chimie et de Physique, 1858 (III), 52,. 404-418. (See 
also The Life of Pasteur, by Vallery-Radot, Vol. I, pp. 108-109 and 129.) 
Boutroux, Compt. rend., 86, 605-607. 
Richet, Compt. rend., 86, 550-552; and ibid., 88, 750-751. 
Marpmann, Arch. Pharm. (3), 24, 243-256. 
Hueppe, Mitth. a. d. Kais. Gesundheitsamt, 2, 1884, 309. 
Beyerinck, Arch. Neer. Sci. Exact. Nat., 1901 (II), 6, 212-243. 
Heinemann, J. of Infect. Dis., 1906, III, 173. 
Heinemann, Jour. Biol. Chem., 1907, II, 603-612. 
Conn, 15th Ann. Rep. Storr's Agr. Exp. Stat., 1903, 92. 
Hirschfeld, Pfluger's Archiv, 47, 510-542. 

Buchner and Meisenheimer, Ber. d. deut. Chem. Ges., 1903, 36, 634. 
Herzog, Zeit. f. Physiol. Chem., 1903, 381. 
Gunther and Thierfelder, Archiv f. Hygien., 1895, 25, 164. 
Gadamer, Apoth. Zeit., 12, 642-643. 
Clafflin, Jour. Soc. Chem. Ind., 1897, 16, 516-518. 
Blumenthal and Wolff, Charite Ann., 29, 12-18. 
Haacke, Arch. Hyg, 1902, 42, 16-47. 
Tissier and Gasching, Ann. Inst. Past, 1903, 17, 540-563. 
Beyerinck, Proc. K. Akad. Wetensch. Amsterdam, 1907, 10, 17-35. 
Epstein, Arch. Hyg., 1900, 329-359. 

V. Freudenreich, Centr. Bakt., 2. Abt., 1902, 8, 735-738. 
Boekhaut and de Vries, Centr. Bakt., 1899, 304. 
Chodat and Hofman-Bang, Ann. Inst. Pasteur, 1901, 15, 36-48. 
Van Slyke, Jour. Amer. Chem. Soc, 1904, 25, 1243-1256. 
Burri and Dueggeli, Centr. f. Bakt. u. Par., 1906, Abt. II, 15, 709-722. 
Fuchs. (See Conn, Agricultural Bacteriology, Phila., 1901, p. 205.) 
Hueppe and Engling, Bied. Centr., 1885, 414-415. 



423 

(30) Reiset, Compt. rend., 96, 682-685; and 745-750. 

(31) Conn, Agricultural Bacteriology, Phila., 1901, p. 205. 

(32) Trillat and Sauton, Compt. rend., 144, 1907, 926-929. 

(33) Struve, Berichte d. deut. Cliem. Ges., 17, 1364-1368. 

(34) Vieth, Analyst, 12, 2-6. 

(35) Von Freudenreicli. See Conn, Agricultural Bacteriology. 

(36) Martinand, Compt. rend., 108, 1067-1069. 

PART II.— (4b) MILK POISONING— GALACTOTOXISMUS. 

(1) Stoakley, Virg. Med. Semiinonth., 1902, 7, 276. 

(2) Vaughan. (See Yaughan and Novy, Cellular Toxines, Phila. and N. Y., 

1902, 211-220.) 

(3) Sonnenberger, Verh. d. Gesell. f. Kinderkeilk., Wiesbaden, 1896 and 1897, 

129-145; and also Munch. Med. Wochschr., 1897, No. 13, 335-338; and 
No. 14, 363-365. 

(4) Le Blanc, Bull, de Lyon Med., 1901, 96, 586. 

(5) Baird, Yirg. Med. Semimonth, 1902, 7, 241-242. 

(6) Golding and Feilmann, Jour. Soc. Chem. Ind., 1905, 24, 1285-1286. 

(7) Bucura, Zeitsch. f. exper. Path. u. Ther. IY, 1907, 398-113. 

(8) Newton and Wallace. (See Yaughan and Novy, loc. cit., p. 215.) 

(9) Firth, ibid., p. 216. 

(10) Yaughan, ibid. 

(11) Camman, ibid., p. 218. 

(12) Kinnicut, ibid. 

(13) Yaughan and Novy, ibid., p. 219. 

(14) Vaughan and Perkins, Archiv. f. Hygien., 27. 

(15) Dokkum. (See Yaughan and Novy, loc. cit., 214.) 

(16) Lepierre, ibid., p. 323. 

(17) Vaughan and Novy, Twentieth Century Practice of Medicine, N. Y., 1898, 

XIII, p. 59. 

(18) Vaughan, Michigan State Board of Health, 1896, 397-^01. 

(19) Novy. (See Osier's Modern Medicine, Phila. and N. Y., 1907, 241-243.) 

(20) Fluegge. (See Yaughan, Twentieth Century Practice of Medicine, N. Y., 

1898, XIII, 50-52.) 

(21) Liibbert, ibid., 52-53. 

(22) Vaughan, ibid., 53-54. 

(23) Van Itallie; Pharm. Weekblad, 45, pp. 1357-1362. 

(24) Reijst-Scheffer ; Arch. Pharm., 246, pp. 595-598. 

PART III.— CHEMICAL STANDARDS FOR THE CONTROL OF THE SALE 

OF MILK. 

(1) P. M. Harwood, Amer. Food Jour., 1907, Aug., p. 33. 

PART IV.— ADULTERATIONS OF MILK. 

(1) Leach, Food Inspection and Analysis, N. Y., 1907, 133-134. 

(2) Steinegger, Zeit. Nahr. u. Genussm., 1905, 10, 659-671. 

(3) Commanducci, Rend. Acad. Sci. Fis. Mat. Napoli, 1906, (III), 12, 113-115. 

(4) Atkins, Chem. News, 97, 1908, 241-242. 

(5) Atlee, Tr. Med. Soc. Tenn., 1907, 54-61. 

(6) Van Slyke, Modern Methods of Testing Milk and Milk Products, N. Y. and 

Lond., 1907, p. 140. 



424 

(7) Winton, Conn. Agr. Exp. Stat. Rep., 1901, 179-182. 

(8) Tolman, U. S. Dept. Agr., Bur. of Chem., Bull. 65, 111-120. 

(9) Houghton, Jour. Amer. Chem. Soc, 1907, 29, 1351-1357. 

(10) Weyl, The Sanitary Relations of the Coal Tar Colors, tr. by M. Leffmann, 

Phila., 1892. 

(11) Weber, Jour. Amer. Chem. Soc, 1896, 18, 1092-1096. 

(12) Winogradow, Zeit. Nahr. u. Genussm., 1903, VI, 589-592. 

(13) Gudemann, Jour. Amer. Chem. Soe., 1905, 27, 1436-1442. 

(14) Chlopin, Zeit. Nahr. u. Genussm., 1902, 5, 241-245. 

(15) Meyer, J. Am. Chem. Soc, 1907, 29, 892-909. 

(16) Budde, Milch Zeit., 1903, No. 44, 690-691. 

(17) Leach, loc cit, p. 140. 

(18) Richmond, Analyst, 1906, 31, 176-180. 

(19) Trillat, Compt. rend., 1904, 138, 720-722. 

(20) Rideal and Foulerton, Exp. Stat. Rec, 1900, 11, 582; from Public Health, 

1899, 11, 554-568. (See also Rideal, on "The use and abuse of pre- 
servatives," Lancet, 1900, I, 228-230.) 

(21) Hehner, Exp. Stat. Rec, 1900, 11, 582-583; from Brit. Food Jour., 1899, 

1, 132. 

(22) Price, Centr. Bakt. Par., Abt. 2, 1905, 14, 65-75. 

(23) Pottevin, Ann. Inst. Pasteur, 1904, VIII, 807. 

(24) Bliss and Novy, Jour. Exp. Med., 1899, IV, 47-80. 

(25) Halliburton, Brit. Med. Jour., 1900, II, 1-2. 

(26) Neumann, Archiv. f. Exp. Path. u. Pharm., 1881, 14, 149-152. 

(27) Cyon, Compt. rend., 1878, 87, 845. 

(28) Gruber, Zeit. f. Biol., 1880, 16, 198. 

(29) Forster, Archiv. f. Hygien, 1884, 2, 75. 

(30) G. T. Welch, Med. Record, 1888, p. 531. 

(31) Chittenden, Dietet. and Hygien. Gaz., 1893, 9, 25. 

(32) Chittenden and Gies, Amer. J. Physiol., 1898, 1, 1-39. 

(33) Liebreich, Effects of Borax and Boracic Acid on the Human System, by 

Dr. Oscar Liebreich, Berlin, 1899, pp. IV. +44. 

(34) Liebreich, Berlin Klin. Wochenschr., 1887, 33, 605. 

(35) Lebbin, Die Medicinische Woche, 1901, 2, 409-410. 

(36) Tunnicliffe and Rosenheim, Jour, of Hyg., 1901, 1, 168-201. 

(37) Liebreich, Second Treatise on the Effects of Borax and Boric Acid on the 

Human System, by Dr. Oscar Liebreich, Lond., 1902, pp. VIII. +87. 

(38) Wiley and Bigelow, U. S. Dept. of Agr., Bur. of Chem., Bull. 84, Pt. I. 

Boric Acid and Borax, 1904, pp. 1-177. 

(39) Brouardel, 4th Internat. Cong. d'Hyg. et de Demographie & Geneve, II. 

p. 352, Sept. 4-9, 1882. 

(40) Wiley, Bigelow, Weber, and others, Influence of Food Preservatives and 

Artificial Colors on Digestion and Health, II, Salicyclic Acid and 
Salicyclates, U. S. Dept. of Agr., Bur. of Chem., Bull. 84, pt. II. 

(41) Lakin, Centr. f. Bakt. u. Par., 1905, 15, Abt. 2, 165-174. 

(42) P. Gordan, Centr. f. Bakt. u. Par., 1904, Abt. 2, 13, 716-728. 

(43) S. Amberg, J. of Biol. Chem., 1, 219-228. 

(44) Jablin-Gonnet, Maly's Jahresber., 1901, 313. 

(45) Rosam, Centralbl. f. Bakt, 1904, Abt. 2, 13, 716. 

(46) Van der Velde, Beitrilge zur Chem. Physiol, u. Pathol., 1904, 5, 558. 

(47) Rubuteau, Etudes Experimentales sur les Effets des Fluorures, Paris, 1867. 

(48) Kolipinski, Med. News, 1886, No. 8, 49. 

(49) Schulz, Archiv f. Exp. Pathol, u. Therap., 1899. 



425 

(50) Heidenhain, Pfluger's Archiv, 1899. 

(51) Weinland, Pfluger's Archiv, 1894, 58. 

(52) Griintzner, Pfluger's Archiv, 1893, 53. 

(53) Czrellitzer, Zur Keuutuiss des Fluornatrium, Diss. Breslau, 1895. 

(54) Kastle aud Loevenhart, Amer. Cheui. Jour., 1900, 24, 509. 

(55) Loeveuhart aud Pierce, J. of Biol. Chein., 1907, II, 397-413. 

(56) Baldwin, Jour. Am. Chem. Soc, 1899, 21, 517-521. 

(57) Van Slyke, loc. cit, p. 29. 

(58) Leffmann, Dietetic and Hyg. Gaz., 1898, 14, 171-173. 

(59) Hope, Report of the Thompson- Yates Laboratories, 1900, Pt. 1, 75-78. 

(60) Yaughan and Yeenboer, Amer. Med., 1902, III, 421-426. 

(61) Rideal and Foulerton, Public Health, 1S99, II, 554-568. 

(62) Richmond, Analyst, 1900, 25, 123-124. 

PART V.— THE WASHINGTON MILK SUPPLY. 

(1) Leach, Food Inspection and Analysis, New York, 1907. p. 130-133. 

(2) Thorner, Chem. Zeit, 1891, 1108. 

(3) Van Slyke, Modem Methods of Testing Milk and Milk Products, N. Y. and 

Loud., 1907, p. 106. 

(4) Tuley, Jour. Amer. Med. Ass'n, 1907, 49, 1344-1349. 

(5) Ott, Zeitschr. f. Fleisch u. Milch Hyg., 1896-97, 7, 214-216. 

(6) Leach, loc. cit, pp. 757-767. 

(7) Wagner, Leber quantitative Bestimmungen waiisseriger Lusunge mit dem 

Zeiss'-schen Eintauch-Refraktometer, Soudershauseu, 1903. 

(S) Leach, loc. cit, p. 767. 

(9) Leach, ibid., p. 766. 

(10) Leach, ibid., pp. 134-137. 

(11) Blyth, Analyst, 1901, 26, 148-150. 

(12) Leach, loc. cit. pp. 140 and 144. 

(13) Rideal and Foulerton, Public Health, 1899, II, 554-568. 

(14) Acree, J. of Biol. Chem., 1906. II, 145-148. 

(15) Atlee, Trans. Med. Soc. Tenn., 1897, 54-61. 

(16) Winslow, Northwestern Medicine, Seattle, 1904, II, 315-327. 

(17) Winslow, ibid., pp. 315-316. 



11. THE NUMBER OF BACTERIA IK MILK AND THE 
VALUE OF BACTERIAL COUNTS. 



(427) 



THE NUMBER OF BACTERIA IN MILK AND THE VALUE OF 
BACTERIAL COUNTS. 



By Milton J. Rosenau, 
Director, Hygienic Laboratory , Public Health and Marine- Hospital Service. 



Milk delivered in cities contains a vast number of bacteria. For 
instance, the general milk supply of Washington averaged 11,270,000 
per cubic centimeter in the summer of 1907; and 22,134,000 during 
the summer of 1906. The milk of many other cities also is exces- 
sively rich in bacteria. 

Such enormous numbers mean but little to our minds. If we 
make comparisons we find that few substances contain such myriads 
of germ life as is often found in milk. Compared with sewage, for 
instance, a fluid which is popularly and rightly supposed to teem 
with germ life, it will almost always be observed that milk when it 
is consumed is richer in bacteria by far than the sewage of our large 
cities. a 



Sewage of — 


Average for— 


Bacteria per cubic 
centimeter. 




1894 to 1901 


2,800,000 

2,000,000 to 11,000,000 

3, 500, 000 to 4,000,000 

3,034,000 

5,600,000 

2,350,000 

239,000 




1894 to 1901 




1898 




Sept. 24 to Oct. 24, 1890. . . 
16 samples, 1907 


St. Mary's, Ohio « 




16 samples, 1907 




16 samples, 1907 







a Winslow and Belcher: Changes in the bacterial flora of sewage during storage. 

6 Laws and Andrews: Report on the result of investigations of the micro-organisms of sewage. Rep. 
London Co. Council, Dec. 13, 1894. 

c Clowes, F.: Report on the bacteriological examination of London crude sewage. First Rep. Lon- 
don Co. Council, June 16, 1898. 

d State Board Health Mass., Rep. 1890, p. 35. 

« Kellerman, Pratt and Kimberly: The disinfection of sewage effluents for the protection of public 
water supplies. U. S. Bur. Plant Industry, Bull. 115, 1907. 

So far as numbers are concerned, they need not greatly alarm us, 
for we know that disease is due to agencies and conditions other 
than merely the presence of enormous numbers of bacteria. By 
universal consent, however, milk containing excessive numbers of 
bacteria is unsuitable for infant feeding. The tender mucous mem- 

a Russell, H. L. Outlines of Dairy Bacteriology, 1896. 
(429) 



430 

brane of infants is very susceptible to bacteria and their products, 
and a large proportion of the summer complaints of infants has 
been traced to the use of bacteria-laden milk. As we grow older 
it seems that the gastro-intestinal mucous membrane becomes 
comparatively immune, or resistant to bacterial action. 

If milk were a transparent fluid the enormous growth of bacteria 
found in market milk would be plainly visible to the naked eye. 
A similar amount of bacterial growth in broth, gelatine, beer, jelly, 
or other clear substance, would render such food unsightly, and it 
would be generally regarded as unfit for use on account of the evi- 
dence of fermentative and putrefactive changes. 

The number of bacteria in milk is not so important from a public 
health standpoint as the kind and nature of the bacterial products. 
But with cleanliness and the liberal use of ice the total number of 
bacteria can be kept down, and this affords a mode of protection 
against the dangerous species and their toxic products. Milk con- 
taining few bacteria will contain proportionately few or no harmful 
varieties. Most of the specific pathogenic bacteria which some- 
times contaminate milk, grow best at the body temperature and 
not at all at the low temperatures at which milk must be kept in 
order to keep the total bacterial count down. 

Park a raises the question — 

Are even these enormous numbers of bacteria in milk during hot weather actually 
harmful? Here we have only to refer to universal clinical experience, that a great 
number of children in cities sicken on the milk supplied in summer, that those put on 
milk which is sterile or contains few bacteria as a rule mend rapidly, while those kept 
on the impure milk continue ill or die. 

Our knowledge is probably as yet insufficient to state just how many bacteria must 
accumulate to make them noticeably dangerous in milk. Some varieties are un- 
doubtedly more harmful than others and we have no way of restricting the kinds that 
will fall into milk except by enforcing cleanliness. We have also to consider that 
milk is not entirely used for some twelve hours after being purchased, and that during 
all this time bacteria are rapidly multiplying, especially where, as among the poor, no 
provision for cooling it is made. Slight changes in the milk which to one child would 
be harmless would in another produce disturbances which might lead to serious dis- 
ease. A safe conclusion is that no more bacterial contamination should be allowed 
than it is practical to avoid. Any intelligent farmer can use sufficient cleanliness and 
apply sufficient cold, with almost no increase in expense, to supply milk twenty-four 
to thirty-six hours old which will not contain in each cubic centimeter over 50,000 
to 100,000 bacteria, and no milk containing more bacteria should be sold. 

Judged by the colonies that develop upon agar plates, the number 
of bacteria in milk increases every time it is handled. Separator 
milk contains more than the original milk. The same is trme of 
filtered milk. Milk strained through gauze or cotton, or filtered 

a Park, W. H.: The great bacterial contamination of the milk of cities, can it be 
lessened by the action of health authorities? Journ. Hyg., vol. 1, 1901, p. 391. 



431 

through gravel or any other device, while it looks clean, always con- 
tains more bacteria than before it has been "purified." This is due 
to the fact that, while the visible particles of dirt are held back, the 
particles of manure, dirt, and bacterial clusters are broken up. Fur- 
ther, unless the most painstaking technical precautions are taken, 
milk receives fresh bacterial contamination every time it is poured 
from one vessel to another or is handled in any other way. 

THE INITIAL CONTAMINATION OF MILK. 

Now that we know that milk freshly drawn from the udder under 
ordinary circumstances always contains bacteria, it is of practical 
importance to determine their number and kind. 

Sedgwick and Batchelder, a 1892, found that with moderate pre- 
cautions on the part of the milker the number of bacteria in fresh 
milk may not exceed 500 to 1,000 per cubic centimeter, but when 
the ordinary flaring milk pail is used, with more or less disturbance 
of the bedding and shaking of the udder, as many as 30,000 bacteria 
have been counted in one cubic centimeter. 

MacConkey, & however, finds that with ordinary care and cleanli- 
ness it is possible to obtain milk which when freshly drawn contains 
less than 1,500 organisms per cubic centimeter; and, further, that 
such milk should not contain gas-forming organisms in less than 50 
cubic centimeters. 

Comparing these results with the work of others, we find that 
Park, c 1901, found the average bacterial content of the milk from 
six separate cows examined five hours after collection to be 6,000 
per cubic centimeter, the lowest count being 400, and of 25 cows of 
which the milk was tested immediately after drawn it was 4,550. 

Burr, d 1902, also taking every reasonable precaution, found 500 
organisms per cubic centimeter in the milk of a single cow. 

Von Freudenreich,* 1902, thought it would be easy to carry out 
strict asepsis and thus obtain a bacteria-free milk; but he soon came 
to the conclusion that this was impossible. He found that milk 
always contained 250 to 300 organisms per cubic centimeter, even 

a Sedgwick, William T., and Batchelder, John L.: A bacteriological examination of 
the Boston milk supply. Boston Med. and Surg. Journ., vol. 126, 1892, p. 25-28. 

*>MacConkey: A contribution to the bacteriology of milk. Journ. of Hyg. vol. 
6, 1906, p. 385. 

c Park, William H.: The great bacterial contamination of the milk of cities, can 
it be lessened by the action of the health authorities? Journ. Hyg., vol. 1, 1901. 
p. 391. 

^Burr, Rollin H.: The source of the acid organisms of milk and cream. Cent. f. 
Bakt., 2 Abt., vol. 8, 1902, p. 236. 

«Von Freudenreich, Ed.: Milchsaurefermente und Kasereifung. Cent. f. Bakt., 
2 Abt., vol. 8, 1902, p. 674. 



432 

though the milker's hands and the teats were washed first with soft 
soap and sterile water and then with servatol soap and sterile water, 
and finally with sterile water alone and dried on a sterile towel. 
The milker's hands were smeared with lanoline and the first milk 
rejected. The bacterial content of the mixed milk of 28 cows milked 
in this way varied from 65 to 680 organisms per cubic centimeter. 

Von Freudenreich and Thoni, a 1903, from a further series of 
similar experiments conclude that freshly drawn milk, even when 
the most careful precautions are taken against contamination, always 
contains bacteria; that these are mostly cocci and that they come 
from the udder. 

Continuing his experiments, Von Freudenreich, 6 1903, states that 
he examined the udders and the milk in the udders of 15 cows, in 13 
cases immediately after slaughtering. The organisms were mostly 
cocci. B. lactis acidi was only met with once. In 3 cases the ducts 
were diseased and in these cases the diseased tissues contained fewer 
organisms than usual. B. coli was never found. He mentions that 
Boekhout and De Vries drew milk directly from the udder with a 
sterile canula and always got a growth from it. 

Lux, c 1904, examined milk drawn without aseptic precautions. 
Two hundred and sixty cow-milk and 95 goat-milk samples were 
analyzed. The average number of bacteria per cubic centimeter was 
1,395, which were mostly nonpathogenic cocci. 

Henderson/ 1904, examined seven normal udders and obtained 
growth in 76 per cent of the cultures made, the organisms being 
staphylococci, streptococci, and pseudo-diphtheria bacilli. No organ- 
isms found were pathogenic to laboratory animals. 

Willem and Miele, g 1905, obtained a milk containing 2.5 bacteria 
per cubic centimeter. The milking was done in a special place, 
which was kept as aseptic as possible. The greatest care was taken 
to insure the cows being clean. The udder and teats were washed 
before each milking with soap and boiled water or an aseptic solution. 

From the examples quoted we see that it is practically impossible 
to obtain bacteria-free milk, but that the organisms in carefully col- 
lected milk are not pathogenic to the usual laboratory animals. We 

a Von Freudenreich, Ed., and Thoni, J.: Ueber die in der normalen Milch vorkom- 
menden Bakterien und ihre Beziehungen zue dem Kasereifungsprozesse. Cent. f. 
Bakt., 2 Abt., vol. 10, 1903, p. 305. 

& Von Freudenreich, Ed.: Ueber das Vorkommen von Hakterien im Kuheuter. 
Cent. f. Bakt., 2 Abt., vol. 10, 1903, p. 401. 

c Lux, Arthur: Ueber den Gehalt der frisch gemolkenen Milch an Bakterien. Cent. 
f. Bakt., 2 Abt., vol. 11, 1903, p. 195. 

d Henderson, J.: Journ. roy. san. inst., vol. 25, 1904, p. 563. 

e Willem and Miele: Procede pour l'obtention du lait au aseptique. Compt. 
Bend, du 13 Cong, internat. d'hyg., Brux. ? 1903, vol, 3, p. 67, 



433 

may allow, then, that the presence of such organisms in reasonable 
number would not render a milk harmful to man. Lux's experi- 
ments have shown that with very ordinary care it is possible to 
obtain a milk containing on an average 1,400 bacteria per cubic 
centimeter, and it is obvious that with some trouble the number 
may be reduced. 

The work of Park," 1901, Nicolle and Petit, 6 1903, Conn and 
Esten, c 1904, Koning/ 1905, Harrison, 6 1905, and others has shown 
that if milk be rapidly cooled to 11° C. (50° F.) or below, very little, 
if any, multiplication of micro-organisms takes place for some twelve 
hours. Therefore Park's suggested average standard of not more 
than 12,000 bacteria per cubic centimeter in warm and 5,000 in cold 
weather for freshly drawn milk seems a generous standard and one 
which, with a little care, should be easily attained. 

It is necessary to note that "separator milk" must not be judged 
by the same standard as fresh milk, for Severin and Budinoff/ 1905, 
and Severing 1905, have shown that even when every possible pre- 
caution is taken against contamination, the milk issuing from the 
separator always contains many more bacteria than it did before it 
passed into the separating chamber. Severin suggests that the 
mechanical movement completes the separation of bacteria which 
were only partially divided when they entered the machine. 

Moore h concludes from a large mass of data that freshly drawn 
fore milk contains a variable but generally enormous number of 
bacteria, but only a few species, the last milk containing as compared 
with the fore milk very few micro-organisms. 

Russell * found that the mixed milk of a herd that is kept with 
any reasonable degree of cleanliness, if examined immediately after 

a Park, Wm. H.: The great bacterial contamination of the milk of cities. Can it 
be lessened by the action of health authorities? Journ. Hyg., vol. 1, 1901, p. 391. 

b Nicolle, C, and Petit, P.: Etude experimentale sur la question du lait a Rouen. 
Rev. med. de Normandia, 1903. Rev. Bull, de l'lnst. Pasteur, vol. 2, 1904, p. 552. 

c Conn, H. W., and Esten, W. M.: The effect of different temperatures in deter- 
mining the species of bacteria which grow in milk. Storrs Agric. Exper. Sta., 16th 
ann. rep., June 30, 1904, pp. 27-88. 

d Koning: Biologische und biochemische Studien uber Milch. Milchwirtschaftl. 
Centblt., vol. 1, 1905; Rev., Cent. f. Bakt., 2 Abt., vol. 14, 1905, p. 424. 

e Harrison, F. C: A comparative study of sixty-six varieties of gas-producing bac- 
teria found in milk. Cent. f. Bakt., 2 Abt,, vol. 14, 1905, p. 359. 

/Severin, S., and Budinoff, L. : Ein Beitrag zur Bakteriologie der Milch. Cent. f. 
Bakt., 2 Abt., vol. 14, 1905, p. 463. 

Severin, S.: Vermindert die Zentrifugierung die Bakterienzahl in der Milch? 
Cent. f. Bakt., 2 Abt., vol. 14, 1905, p. 605. 

& Moore: TJ. S. Bur. Animal Indus., 1895-6. 

* Russell, H. L.: Outlines of dairy bacteriology, 1896, p. 59 

45276°— Bull. 56—12 28 



434 

milking, usually will not contain more than 5,000 to 20,000 germs 
per cubic centimeter. 

I have found the milk obtained by careful methods from separate 
cows to contain the following number of bacteria per cubic centi- 
meter immediately after milking: 60, 160, 400, 400, 500, 500, 8,300. 

All these counts are evidently too low, for the reason that not all the 
bacteria produce visible colonies upon agar plates, and further each 
colony does not necessarily represent the growth from one micro- 
organism. Rosenau and McCoy have shown elsewhere (upon the 
germicidal property of milk this Bulletin, p. 447) that the bacteria 
in milk are apt to agglutinate into clusters. 

LEGAL STANDARDS. 

The first attempt to make a standard for the bacteriological con- 
tent of milk was undertaken by the New York board of health, 
which, in 1900, believed it was not necessary for any milk sold in 
New York to contain over 1,000,000 bacteria per cubic centimeter. 
It was found, however, practically impossible to enforce such a 
standard for the city of New York on account of the complexity 
and enormous volume of the milk trade of that city. The princi- 
pal difficulty was to place the responsibility when milk was found 
to contain an excessive number of bacteria, as the milk passed 
through so many hands before it was delivered to the consumer. 

Boston, on the other hand, made a strict standard of 500,000 
bacteria per cubic centimeter, which was legalized by the board of 
health June 6, 1905, in article 6, section 1, of the Regulations for 
the Sale and Care of Milk. According to Jordan, a the adoption of a 
bacteriological standard by the Boston board of health has been 
decried and the subject of scoffing, but the example of that city 
has since been followed by other municipalities, until now nearly 
20 cities are conducting bacteriological investigations of milk sup- 
plies. This outcome is fortunate, for from multiplication of work 
of this character great progress may be expected. 

Goler, 6 health officer of the city of Rochester, issued a circular 
to all milk producers supplying that city, informing them that 
thereafter 100,000 bacteria per cubic centimeter would be made a 
maximum standard. 

a Jordan, James 0.: Boston's campaign for clean milk. Journ. Am. Med. Assn., 
vol. 49, Sept. 28, 1907. 

b Goler, George W.: Municipal regulation of the milk supply. Trans. Soc. on 
Hyg. & San. Science, A. M. A., June 1907, p. 251. 



435 

Bitter a believes that no milk should be sold in cities containing 
more than 50,000 bacteria per cubic centimeter. 

Park 6 states that any intelligent farmer can use sufficient cleanli- 
ness and apply sufficient cold with almost no increase in expense to 
supply milk twenty-four to thirty-six hours old which will not con- 
tain in the maximum over 50,000 to 100,000 bacteria per cubic 
centimeter, and that no milk containing more bacteria than this 
should be used. 

The above figures apply to standards that have been set on market 
milk. So far as milk for infant feeding and other clinical purposes 
is concerned, the standard established by Coit of 10,000 bacteria per 
cubic centimeter as a maximum seems, by almost unanimous consent, 
to be the best. Some communities have adopted a second grade 
of milk known as " inspected" milk from tuberculin-tested cattle 
and obtained under cleanly conditions, and not containing over 
100,000 bacteria per cubic centimeter. 

The number of bacteria, therefore, allowable in milk depends upon 
the purposes for which it is used and varies somewhat with the 
locality. It is evidently easier to obtain milk containing fewer 
bacteria in small communities with a near-by supply and in cold 
climates, than it is in larger cities with inevitable delays in trans- 
portation or in southern latitudes. 

As a general rule it may be stated that " certified " milk should never 
exceed 10,000 bacteria per cubic centimeter, " inspected" milk not 
over 100,000, and health officers should aim to keep the general 
milk supply below the 100,000 mark. 

THE PRACTICAL VALUE OF BACTERIAL EXAMINATIONS OF MILK. 

The activities of our health officers were at first directed almost 
exclusively to the prevention of sophistication of milk, detected by 
chemical methods, to the neglect of the valuable information obtained 
from bacterial examinations. 

The addition of water to milk and the extraction of cream are 
fraudulent practices, but, as a rule, have only a secondary bearing 
upon the public health. The bacteriologic examination of milk 
gives us a clew to the cleanness of the methods employed, the tem- 
perature, and the age of the milk. The health officer who has the 
advantage of bacteriologic assistance knows that the milk of dairies 
containing excessive numbers of bacteria is dirty, old, or warm. 

a Bitter, H.: Versuche iiber das Pasteurisiren der Milch. Zeit. f. Hyg., vol. 8, 
1890, p. 240. 

& Park, William H., and Bebb, Rose A.: The great bacterial contamination of the 
milk of cities. Can it be lessened by the action of health authorities? N. Y. Univ. 
Bull. Med. ScL, vol. 1, 1901. 



436 

With a bacteriologic count as a guide it is comparatively easy to 
determine the cause of the trouble and to institute proper means to 
correct it. The enumeration of bacteria in milk is, therefore, one of the 
readiest and cheapest methods at the disposal of health officers to 
determine the general sanitary quality of the market milk supply. The 
laboratory results serve not only as a guide to direct the efforts of 
the health officer, but confirm the conclusions arrived at from an 
inspection of the dairies and dairy farms. 

While the bacteriological examination of milk has its uses, it also 
has distinct limitations. From a practical standpoint the long time 
required to obtain results is its greatest drawback. The qualitative 
determinations of the bacterial species in milk is too complex and 
difficult a method to adopt as a routine procedure. It is otherwise 
with quantitative counts. These determinations are comparatively 
easy and are of invaluable assistance to the progressive dairyman in 
controlling his methods and in discovering just which cow, what 
person, or what part of the industry is at fault when things go wrong. 

It is comparatively easy to make bacterial counts of milk, and for 
practical purposes the method may soon be learned even by one not 
skilled in bacteriologic technique. Dairymen will find it to their 
advantage to make agar plates and roughly estimate the number of 
bacteria, not only of their finished product, but from individual cows 
and during various stages in the handling of the milk. 

In fact, a number of progressive dairymen are already using bacteri- 
ologic counts of their milk in order to improve the supply. In 
Boston, Jordan tells us that in 1906, six milk firms made over 27,000 
such examinations. 

In Kochester, Goler° has obtained a reduction in the average bac- 
terial count of the milk supply of that city from 837,000 per cubic 
centimeter in 1900 to 200,000 in 1903. In 1900, 26 per cent of the 
samples examined contained over 5,000,000 bacteria per cubic centi- 
meter; in 1903 only 4 per cent contained over 5,000,000. At the time 
the city milk supply contained an average of 235,000 bacteria per 
cubic centimeter, the milk that was procured under a process of cer- 
tification and education contained but 14,000 bacteria per cubic 
centimeter for the same period. 

In Washington the bacteriological examinations made in the 
Hygienic Laboratory and submitted to the dairies by the local health 
officer have stimulated the dairymen to use more ice, with the result 
that during the summer of 1907 the average temperature of 316 
samples of milk examined was 2.3° C. lower than during the correspond- 
ed Goler, G. W.: The influence of the municipal milk supply upon the deaths of 
young children. N. Y. State Journ. Med., vol. 3, 1903, p. 493. 



437 

ing term for 1906, and the average number of bacteria per cubic 
centimeter was cut in half. Convinced of the practical advantages 
of the bacteriological control of milk, one progressive dairyman in 
Washington has employed a competent bacteriologist to assist him 
in marketing a better quality of milk. 

One great advantage accruing from the bacteriological control of 
milk is that it affords an opportunity to exclude the milk of diseased 
cows. Cows frequently suffer with diseases of the udder; in fact, 
garget or mammitis is the most common of all bovine diseases. Milk 
from inflamed udders containing pus-producing organisms (strep- 
tococci) is believed by some to be more important than the pep- 
tonizing species, about which much has been said since the work of 
Fliigge. 

Fresh milk from cows with diseased udders contains an excessive 
number of streptococci and pus cells or an excess of pus cells alone. 
So far as we know, such milk is dangerous for infant feeding. While 
not all agree with this view, nor is there any agreement concerning 
what constitutes an excessive number of streptococci and pus cells in 
milk, the facts have been put to practical use by Jordan in Boston. 
There, milk " infected" with excessive numbers of streptococci or an 
excess of pus was traced back to the cow, with the result that thirty- 
one diseased cows supplying milk to Boston in 1906 were found and 
eliminated. Most of the animals had mammitis or garget ; some had 
ulcerated teats, some had recently calved, and others were approach- 
ing the calving period, etc. a 

BACTERIAL COUNTS OF WASHINGTON MILK. 
METHODS. 

The number of bacteria found in any given sample of milk will 
vary with the methods used. It is not possible by any known 
method in bacteriology to determine the exact number of live bac- 
teria in a sample of milk. The counts obtained are always below 
the actual number present. This is due to a number of reasons. 
First of all the bacteria stick together in groups and clusters; some 
are held together by adhesive membranes in pairs, chains, or masses. 
It is therefore evident that a single colony on a plate may not rep- 
resent the growth from a single micro-organism. 

It is impossible to obtain a medium, temperature, and other condi- 
tions suitable to the requirements of all bacteria. Some grow best 
at high temperatures, others at low; some prefer acid, others alka- 
line media; some need oxygen, which is fatal to others, etc. 

a- Thirty-fifth ann. rep. city of Boston, Health Dept, 1906. 



438 

After careful consideration of the subject the following methods 
have given satisfactory results in this laboratory : a 

The samples were always collected in the original containers, 
either pint or quart bottles being purchased for our purposes. Some 
of these samples were obtained from the wagon on the street, others 
from the dairy, and still others were obtained from houses in various 
parts of the city, at once after being delivered in the usual course of 
trade. It is therefore believed that the samples examined fairly rep- 
resent the average milk obtained by the householder. The samples 
were collected early in the morning and at once placed in a metal con- 
tainer filled with cracked ice. From six to eight samples were collected 
each morning from various parts of the city, and rarely more than two 
hours elapsed from the collection of the first sample to the time it was 
received in the laboratory. The temperature was taken with a good 
thermometer at the time the sample was collected, but always from 
a different bottle, which was afterwards used for chemical purposes. 

It was noted that after the milk stood on ice for some time that 
there might be a difference of 6 to 8 degrees between the top and the 
bottom layers of the milk in a pint bottle. The milk was always 
shaken well in order to mix the cream and to help break up the bac- 
terial clumps before the bottle was opened, which was done with the 
usual bacteriologic precautions. For ordinary market milk the fol- 
lowing dilutions were made : 

1 cubic centimeter milk + 99 cubic centimeters sterile water. 

0.1 cubic centimeter of this was used for the first plate, which rep- 
resented 1:1,000. 

0.5 cubic centimeter of the first dilution was then added to 49.5 
cubic centimeters of sterile water. One cubic centimeter of this dilu- 
tion when plated represented 1:10,000, and 0.1 cubic centimeter of 
this dilution represented 1 : 100,000. 

The dilutions were vigorously shaken at least twenty-five times in 
accordance with the standard methods for water analysis in order to 
obtain uniform suspension of the bacteria. Sterile distilled water was 
used as a diluent. 

The final dilution was measured directly into a petri dish and agar 
poured at a temperature of between 40° and 45° C. in the usual way. 

After the plates were well set, they were grown at 37° C, which 
temperature appears not only to favor the maximum growth of 
bacteria ordinarily found in the milk, but has the additional advan- 
tage of favoring the kinds of bacteria belonging to the pathogenic 

a Since writing this "article the committee on standard methods of bacterial milk 
analysis have presented a preliminary report, which appeared in the American Journal 
of Public Hygiene, vol. 17, November, 1907, pp. 331-364. At the Winnipeg meeting 
of the American Public Health Association in September, 1908, the committee pre- 
sented a report of further progress, an abstract of which appeared in the American 
Journal of Public Hygiene for November, 1908, p. 425. (See also Heineman and 
Glenn's recent article on "A comparison of practical methods for determining the 
bacteriological content of milk," Journ. Infectious Diseases, vol. 5, Oct. 20, 1908, pp. 
412-420.) f 



439 



class. The plates were counted at the end of twenty-four hours, 
although by that time the maximum growth had not appeared. 
Only those colonies were counted which were visible to the naked 
eye or could be seen with a low-power magnifying glass. Three 
plates were always made from each sample, one from each dilution. 
Plates that became spoiled owing to spreading of the surface growths 
over them, irregular distribution, or excessive numbers, were dis- 
carded. The counts were always taken when possible from plates 
containing 200 or less bacteria per plate, the reading being reduced 
to round numbers. 

The composition of the media used for this work was 1.5 per cent 
agar and an acidity of + 1.5 to phenolphthalein as an indicator. 

In accordance with this method a number of samples of milk 
bought on the open market in Washington were examined in the 
Hygienic Laboratory, P. H. & M. H. S., during the summer months 
of 1906-7, the results of which appear in the following tables: 

Results of bacterial counts of market milk in Washington, 1906 and 1907. 



Name. 


Date. 


Samples obtained at— 


Tempera- 
ture of 
milk 

when ob- 
tained 
(°C). 


Number of 
bacteria 
per cubic 

centimeter. 




[July 10,1907 
July 22,1907 
Aug. 5,1907 
LAug. 19,1907 
[July 15,1907 
July 30,1907 
July 31,1907 
lAug. 30, 1907 
[July 11,1907 
lAug. 26, 1907 
J Aug. 1,1907 
lAug. 27, 1907 
{July 12,1907 
lAug. 7,1907 
[July 24,1907 
jjuly 29,1907 
I.Aug. 20, 1907 
J Aug. 30, 1906 
ljuly 13,1907 
Aug. 6, 1907 
[July 16,1907 
lAug. 2, 1907 
(July 12,1907 
Jjuly 22,1907 
[Aug. 14,1907 
lAug. 28,1907 
Aug. 6,1906 
Sept. 5,1906 
....do 




9 
10.5 

9 

6 

17 
22 
11 
23 
18.2 

7.5 
19.5 
14 

26.5 
24 
20 
20 
13 

14.5 
16 
27 
21 
19 
10 
12 

7 

18 
8 
11 
22 
20 
17 


8,000 


As 


Wagon 


69,000 




Dairy 


2, 680, 000 




do 


170, 000 
2, 240, 000 
5, 150, 000 






All 


Providence Hospital 

do 




111,000,000 




Dairy 


190, 000 
1,700,000 


Al 








1, 090, 000 
22, 500, 000 


Alt 


do 




do 


2, 400, 000 
26, 000, 000 








Dairy 


870, 000 




do 


350, 000 


Art 


Wagon 






2, 560, 000 




do 


950, 000 
18, 300, 000 


Av 


Dairy 






3, 660, 000 


B 


Wagon 






1,000,000 


Ba 


do 


2, 800, 000 




do 


880, 000 

700,000 

2, 180, 000 






Bee. 






Dairy. 


11, 700, 000 




do 


320,000 
1, 380, 000 




Wagon 




Dairy 


166, 000 


Be 


Wagon 


260, 000 




July 6, 1907 
Aug. 8, 1907 
Aug. 20, 1907 




34,000 
23, 600, 000 




Dairy 






94,000 



440 

Results of bacterial counts of market milk in Washington, 1906 and 1907 — Continued. 



Name. 



Date. 



Samples obtained at- 



Tempera 

ture of 

milk 

when ob 
tained 
(°C). 



Number of 
bacteria 
per cubic 

centimeter. 



Bel. 



Ch. 



Ben 
Br. 
Bri. 

Bro 

Bu. 
Ca.. 

Car. 

Ce.. 
C... 



Aug. 13,1906 
Aug. 16,1906 
Sept. 10, 1906 
Sept. 11, 1906 
Sept. 12, 1906 
Sept. 13, 1906 
Sept. 14, 1906 
Sept. 15, 1906 
Sept. 17, 1906 
Sept. 18, 1906 
Sept. 19, 1906 
Sept. 20, 1906 
Sept. 21, 1906 
July 6,1907 
July 23,1907 
July 24,1907 
July 25,1907 
July 26,1907 

..do 

Aug. 1,1907 
Aug. 2, 1907 
Aug. 5,1907 
Aug. 19,1907 
July 17,1907 
Aug. 7,1907 
July 30,1907 
July 31,1907 
Aug. 7,1907 
July 5, 1907 
July 11,1907 
July 29,1907 
July 19,1907 
July 6, 1907 
July 23.1907 
Aug. 6, 1907 
Aug. 20,1907 
July 5, 1907 
July 16,1907 
July 25,1907 
Aug. 13,1907 
Aug. 30,1907 
Aug. 13,1906 
Aug. 16,1906 
Aug. 21,1906 
Aug. 22,1906 
Aug. 23,1906 
Aug. 24, 1906 
July 10,1907 
July 17,1907 
July 25,1907 
July 29,1907 
Aug. 1,1907 
Aug. 23,1907 



Wagon. 
Dairy.. 
Wagon. 
....do. 
....do. 
....do. 
....do. 
....do. 
....do. 
....do. 
....do. 
....do. 
....do. 



Wagon 

Dairy 

Wagon 

Children's Hospital. 

do 

Columbia Hospital. 

do 

Wagon 

....do 



Dairy. 



Wagon . 
....do. 
....do. 



Dairy. 



Dairy.. 
Wagon. 
Dairy.. 



Dairy.. 
....do. 
....do. 
....do. 
....do. 
Wagon . 
....do. 
....do. 
....do. 



Dairy. 
....do. 
....do. 



11 
17 
11 
12 
17 
21 
19 
10 
12 
21 

8 
18 
14 
14 
16 
13 
11 
11 
21 
14.5 

9 
20 
18 
18 
20 

9.5 
12 

9 

9.5 
12.5 
19 
15 
13 
15 
16 
12 



8 

11 

11 
6.5 
9.5 

10 

10 

73.5 



6,200,000 

3,600,000 

5,400,000 

8,900,000 

5,200,000 

370,000 

8,700,000 

1,500,000 

9,700,000 

17,600,000 

69,600,000 

7,900,000 

20,000,000 

2,300,000 

3,520,000 

14,400,000 

730,000 

1,920,000 

2,000,000 

3,660,000 

15,000,000 

8,000,000 

3,000,000 

4,300,000 

55,000,000 

1,620,000 

150,000 

113,000 

51,000 

16,300,000 

20,000,000 

6,800,000 

33,000,000 

30,800,000 

840, 000 

6,000,000 

176,000 

101,000 

800,000 

4,000,000 

70,000 

3 

36,000 

17,000 

190, 000 

64, 000 

42,000 

7,000 

140, 000 

30,000 

25,000 

23,000 

2,000 



441 



Results of bacterial counts of market milk in Washington, 1906 and 1907— Continued. 



Name. 


Date. 


Samples obtained at— 


Tempera- 
ture of 
milk 

when ob- 
tained 
(PC.). 


Number of 
bacteria 
per cubic 

centimeter. 




/Aug. 13,1906 
Aug. 20,1906 
Aug. 28,1906 
Sept. 11, 1906 
Sept. 12, 1906 
Sept. 13, 1906 
Sept. 14, 1906 
Sept. 15, 1906 
Sept. 17,1906 
Sept. 18, 1906 
Sept. 19, 1906 
Sept. 20, 1906 
Sept. 21, 1906 
July 16,1907 
Aug. 2,1907 
Aug. 21,1907 
Aug. 27,1907 
VAug. 30,1907 
rJuly 19,1907 
ljuly 30,1907 
[Aug. 13,1907 
July 31,1907 
Sept. 6, 1906 
July 16, 1907 
Aug. 2, 1907 
Aug. 9, 1907 
Aug. 21, 1907 
Aug. 30, 1907 
[July 31, 1907 
JAug. 22, 1907 
[Aug. 26, 190" 
JAug. 3, 1906 
lAug. 9, 1907 
[July 15,1907 
■ do 




17 
15 
12 
23 
22 
20 
21 
15 
19 
22 
21 
18 
22 
21 
16 
13 
14 

8 
14 
14 
12 
17 
11 

14.5 
15 
16 
15 
15 
14 

9 
13 

21.5 
19.5 
13.5 
18 
12 

15.5 
15 

9 
15 

8.5 
17 
19 
12 
21 

14.5 
14 
11 

22.5 
24 
23 
19 


2,500,000 






44,000,000 




do 


33,000,000 






22,800,000 




do 


9,870,000 




do 


10,700,000 




.do 


7, 400, 000 




.do 


1,010,000 


Che 


do 


550,000 




.do 


11,000,000 




.do 


44, 000, 000 




do 


14, 900, 000 




do 


5, 800, 000 






30,800,000 






8,900,000 




do 


61,000,000 
1,900,000 




do 


21,000,000 




do 


208, 000 


Cla 


do 


500,000 




.do 


540, 000 


Cle 


do.., 


10, 300, 000 




Wagon 


4,860,000 






113,000 






3,200,000 


Clo 








1,600,000 




do 


4,000,000 






1,700,000 






2,500,000 




D " 


8,900,000 




do 


2,100,000 




Wagon 


12,500,000 




do 


160,000 




do 


2,280,000 




.do 


740, 000 


Cud 


lAug. 7,1907 
[Aug. 22, 1907 
[Aug. 13,1906 

Sept. 25,1906 

July 5, 1907 
jjuly 17,1907 

July 25,1907 

Aug. 7,1907 
Lug. 29,1907 

Aug. 2,1906 
[July 19,1907 

July 31,1907 
[Aug. 22,1907 
[July 8, 1907 
J July 18,1907 
[Aug. 22,1907 

July 30,1907 


do 






810, 000 




do 


2,900,000 




do. ' 


11,200,000 
380,000 




do 


5,450,000 


Du 




65,400.000 






4,000,000 






116,000 




do 


710,000 


Ec 


Wagon 


5,900,000 






1,180,000 


Ed 




4,000,000 






221,000 






33,000 


Edw 




420,000 




do 


600,000 






2,500,000 



442 

Results of bacterial counts of market milk in Washington, 1906 and 1907 — Continued. 



Name. 



Date. 



Samples obtained at- 



Tempera- 

ture of 

milk 

when ob- 
tained 
(°C). 



Number of 
bacteria 
per cubic 

centimeter. 



Ev. 



Qle. 



Fa 

Fr 

Fy 
Ga 
Gi. 

Gl. 



Go. 



'Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
July 
July 
July 
,Aug. 
Aug. 
Aug. 
Sept. 
July 
July 
July 
Aug. 
Aug. 
Aug. 
Sept. 
July 
July 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
July 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
July 
July 
July 
Aug. 
Aug. 
July 
Aug. 
Aug. 



8,1906 
10,1906 
13, 1906 
14, 1906 
15, 1906 
16, 1906 
17, 1906 
20,1906 

22. 1906 
9,1907 

15. 1907 
24, 1907 
12, 1907 

20. 1906 
21,1906 

5. 1906 

5. 1907 
17,1907 
25,1907 

9, 1907 

19. 1907 
22, 1906 

25. 1906 
9,1907 

31,1907 

15. 1907 
29, 1907 

2. 1906 
2,1907 

20, 1907 
22, 1907 
10, 1907 
16, 1907 
1,1907 
6,1907 
19, 1907 
27, 1907 

29. 1906 
11,1907 

15. 1907 
29, 1907 
19, 1907 
26, 1907 
13, 1907 

6. 1907 
29, 1907 



Wagon. 
....do.. 
....do.. 
....do. 
....do., 
....do. 
....do. 
....do. 
Dairy. . 



Dairy. 



Dairy. 
....do. 
....do. 



Dairy . 
....do. 



Dairy 



Wagon. 

Dairy. . 

Wagon. 

....do.. 
.•...do.. 
do.. 

....do., 

....do.. 

Dairy. . 

Wagon. 

do. 

do. 

do. 

Wagon. 



Wagon. 
Dairy.. 
Wagon. 
Dairy.. 



15 
16 
15 
15 
15 
17 
16 
23 
16 

5 

14 
16 

2 
13 
15 
16 
15 

13.5 
11 
17 

8 
14 
11 

13.5 
18.5 
10.5 
15 
24 
11 
15 
19 
20 
18 

10.5 
17 
13 



20.5 
11.5 
12 
14 
8.5 
11 



Dairy. 
....do. 



9,200,000 

45,900,000 

15,600,000 

18,200,000 

8,400,000 

2,500,000 

6,800,000 

19,200,000 

28,800,000 

5,700,000 

14,400,000 

16,000,000 

2,140,000 

2,400,000 

4,300,000 

1,930,000 

1,320,000 

11,100,000 

1,600,000 

720,000 

1,500,000 

1,640,000 

2,800,000 

74,000,000 

416,000 

5,000,000 

2,000,000 

220,000 

2,900,000 

6,600,OU0 

11,500,000 

10,300,000 

170,000 

1,320,000 

123,000 

700,000 

2,100,000 

1,655,000 

4,300,000 

4,000,000 

11,800,000 

10,000,000 

29,800,000 

930,000 

6,000 

690,000 



443 

Results of bacterial counts of market milk in Washington, 1906 and 1907 — Continued. 



Name. 



Date. 



Samples obtained at- 



Tempera- 

ture of 

milk 

when ob- 
tained 
(°C). 



Number of 
bacteria 
per cubic 

centimeter. 



Gr. 



Gy. 



Ha. 



Har. 



He. 



Hi, 



Hil. 



Ho. 



Hor. 
Hou. 
Hy.. 



Aug. 14,1906 
Aug. 15,1906 
Aug. 16,1906 
Aug. 27,1906 
July 13,1907 
July 18,1907 
July 24,1907 
July 26,1907 
Aug. 12,1907 
Aug. 20,1907 
Aug. 15,1907 
Aug. 6, 1906 
Sept. 25, 1906 
July 17,1907 
Aug. 5,1907 
Aug. 27,1907 
July 17,1907 
Aug. 12,1907 
Aug. 21,1907 

....do 

....do 

Aug. 30,1907 
Aug. 28,1906 
Aug. 31,1906 
July 12, 1907 
Aug. 12, 1907 
Aug. 23, 1907 
Aug. 8, 1907 
Aug. 23, 1907 
Aug. 7, 1906 
Aug. 20, 1906 
Aug. 21, 1906 
July 5, 1907 
July 25,1907 
Aug. 27,1907 
Aug. 3,1906 
Aug. 2,1907 
July 12,1907 
July 26,1907 
Aug. 16,1907 
Aug. 28, 1907 
July 16,1907 
Aug. 20, 1907 
Aug. 9,1907 
Aug. 30, 1907 
July 25,1907 
Aug. 12,1907 



Wagon. 
....do.. 
....do. 
Dairy.. 



Wagon. 



....do., 
Dairy.. 
Wagon. 
Dairy. . 



Dairy 

Wagon 

do 

do 

do 

Georgetown Hospital. 

do 

Wagon 

Wagon '.. 

Dairy 



Dairy.. 
....do. 
Wagon. 
....do.. 
....do. 
Dairy. . 
....do.. 
....do.. 



Wagon . 
....do. 
....do. 



Dairy. . 

do. 

Wagon. 

do. 

....do. 
....do. 
....do. 
....do. 
....do. 



20 
17 
16 
15 
14 
13 
20 
12 

18.5 
18 
6 
22 
11 



6.5 
18 
18 
19 
19 
12 
17 
14 
15 
12 
14 
16.5 

9.5 



8.5 
22 
23 
18 
17 
23 
12 
24 
21 

9 
13 

8.5 

7.5 
20 
20 
23 
19 
24 
22 



27,000, 

36, 600, 

4,000, 

11,300, 

1,560, 

2,170, 

2,000, 

2,340, 

14,100, 

2,300, 

520, 

1,800, 

2,500, 

3,500, 

1,020, 

2,200, 

2,520, 

4, 150, 

19,200, 

50,000, 

4,000, 

34, 

50, 400, 

43, 100, 

41,000, 

115, 000, 

14, 200, 

17,000, 

3,600, 

4,200, 

5,300, 

6,600, 

1, 240, 

3,280, 

1,050, 

42,000, 

243, 

2,100, 

1,040, 

4,300, 

9,700, 

4,300, 

10, 

560, 

36,800, 

7,000, 

12,000, 



000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 



444 



Results of bacterial counts of market milk in Washington, 1906 and 1907 — Continued. 



Name. 



Date. 



Samples obtained at- 



Tempera- 

ture of 

milk 

when ob- 
tained 
(°C). 



Number of 
bacteria 
per cubic 

centimeter. 



In. 



Ja. 



Je. 



Kl.. 

La.. 
Le.. 

Li.. 

M... 

Ma- 
Mar 

Mc. 

Me.. 
Mi.. 

Mo.. 
Mor. 



Aug. 13 
Aug. 27 
Aug. 29 
Aug. 30 
July 9 
July 22 
July 24 
July 29 
Aug. 7 
Aug. 12 
....do. 
Aug. 13 
Aug. 14 
Aug. 15 
Aug. 16 
Aug. 17 
July 22 
Aug. 7 
Aug. 23 
Aug. 28 
Sept. 11 
Sept. 12 
Sept. 13 
Sept. 14 
July 10 
July 26 : 
Aug. 23 
Aug. 9 
Aug. 22 
Aug. 28 
July 23 
Aug. 21 
Aug. 16 
Sept. 25 
July 6 
July 24 
Aug. 15 
fJuly 29 
\Aug. 27 
Aug. 14 
Aug. 9 

f do 

lAug. 20 ; 
fJuly 30 
lAug. 29 
July 13 
Aug. 6 
Aug. 15 
Aug. 28 
Aug. 23 



1906 
1906 
1906 
1906 
1907 
1907 
1907 
1907 
1907 
1907 



1906 
1906 
1906 
1906 
1906 
1907 
1907 
1907 
1906 
1906 
1906 
1906 
1906 
1907 
1907 
1907 
1907 
1906 
1906 
1907 
1907 
1906 
1906 
1907 
1907 
1907 
1907 
1907 
1907 
1907 



1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 



Dairy. . 
....do. 
Wagon. 
....do.. 



Dairy 

Garfield Hospital 

....do 

Dairy 

Wagon 

....do 

....do 

....do 



Dairy. . 
....do. 
Wagon. 
....do. 
....do. 
....do. 
....do. 



Wagon. 
Dairy.. 
Wagon . 



Wagon . 
....do., 
Dairy.. 
....do.. 



Dairy. . 
Wagon . 
....do.. 
....do. 
....do.. 
....do. 
....do.. 
....do. 
....do.. 



Dairy.. 
....do.. 
....do.. 
Wagon. 



15.5 

15 

10.5 

12 

14 

12 

18 

18 

17 

20 



18.5 

19 

21 

15 

19 

15 

14 

9 
16 
14 
16 
18 
18 

16.5 
18 

9 
16 
22 
17 
21 
20 
12 
10 
16 
17 
19 
18 
15 
18 
25 
15 
10 
21 
16 
10 
12.5 



12 



27,000,000 

23, 400, 000 

30,600,000 

53,400,000 

8,800,000 

1, 710, 000 

480,000 

1,190,000 

10,000,000 

340,000 

10,000,000 

50,400,000 

40,600,000 

5,700,000 

30, 600, 000 

4,800,000 

49,600,000 

4, 900, 000 

1, 990, 000 

65,820,000 

40,800,000 

3,900,000 

1,415,000 

24,600,000 

59, 200, 000 

4,000,000 

3,800,000 

3,800,000 

2,400,000 

5,000,000 

7,200,000 

1,500,000 

145,800,000 

3,100,000 

1,050,000 

45,000,000 

28,000 

170,000 

80,000 

2,300,000 

16,200,000 

250,000 

350,000 

280,000,000 

23,600,000 

57,400,000 

31,000,000 

27,000,000 

4,200,000 

520,000 



445 

Results of bacterial counts of market milk in Washington, 1906 and 1907 — Continued. 



Name. 



Date. 



Samples obtained at- 



Tempera- 
ture of 
milk 

when ob- 
tained 
(°C). 


Number of 
bacteria 
per cubic 

centimeter. 


15 


550,000 


13 


11,800,000 


14 


42,000,000 


8.5 


100,000 


4.5 


1,420,000 


21 


55,200,000 


23 


40,500,000 


18 


43,800,000 


11 


3,300,000 


22 


63,000,000 


17 


34,200,000 


17 


39,000,000 


19 


132,000,000 


20 


63,600,000 


13.5 


510,000 


12 


560,000 


9 


480, 000 


8 


1,900,000 


9 


97,000 


10 


2,900,000 


12 


660,000 


17.5 


24,000,000 


14.5 


130,000 


17 


1,210,000 


10 


6,806,000 


9 


17,000,000 


8 


13,400,000 


23.5 


135,000 


21 


6,000 


14 


13,470,000 


14 


6,700,000 


18 


7,000,000 


16.5 


3,850,000 


18.5 


19,300,000 


21 


28,000,000 


16 


10,000,000 


13 


1,505,000 


11 


34,600,000 


16 


69,000,000 


10 


440,000 


11 


44,000,000 


21 


430,000 


20 


500,000 


17 


3,900,000 


12 


1,150,000 


9 


4,000,000 


24 


94,000 


23 


8,000 


25 


1,000,000 


20 


1,500,000 


10.5 


15,800,000 


23.5 


16,000,000 



Mou. 



Na. 



No. 



Ou. 



Ox. 



Pe. 



Po. 



Py- 



Qu. 



Re.. 
Rei. 
Reu. 
Ri.. 



Aug. 29 : 
Sept. 26, 
July 18 : 
July 29 : 
Aug. 26, 
Aug. 8, 
Aug. 10, 
Aug. 27, 
Sept. 8, 
Sept. 10, 
Sept. 11, 
Sept. 12, 
Sept. 13, 
Sept. 14, 
July 10, 
Aug. 9, 
Aug. 28, 
Aug. 29, 
I^Aug. 30, 
Sept. 5, 
Sept. 25, 
July 15, 
Aug. 8, 
Aug. 22, 
Aug. 30, 
Aug. 31, 
Aug. 14, 
Aug. 6, 
Aug. 16, 
Aug. 16, 
Aug. 23, 
Aug. 29, 
July 6, 
July 16, 
July 23, 
Aug. 8, 
Aug. 20, 
Aug. 27, 
(-July 12, 
Aug. 8, 
I Aug. 19, 
Aug. 5, 
Aug. 19, 
July 9, 
July 29, 
Aug. 16, 
[July 15, 
I Aug. 16, 

do.. 

Aug. 14, 
July 18, 
Aug. 3, 



Wagon 
Dairy.. 



1906 
1906 
1907 
1907 
1907 
1906 
1906 
1906 
1906 
1906 
1906 
1906 
1906 
1906 
1907 
1907 I Dairy 



Dairy.. 
....do.. 
Wagon. 
....do.. 
Dairy.. 
Wagon. 
....do.. 
....do.. 
....do.. 
....do.. 
....do. 



1907 
1907 
1907 
1906 
1906 
1907 
1907 
1907 
1906 
1906 
1907 
1907 
1907 
1906 
1906 
1906 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 



1907 
1907 
1906 



....do.. 
....do.. 
....do.. 
Wagon. 
Dairy.. 
Wagon. 
....do.. 
....do.. 
Dairy.. 
....do.. 
....do.. 
Wagon. 
....do.. 
Dairy. . 
Wagon. 
....do.. 



Wagon. 
....do. 
Dairy . . 



Wagon. 



Dairy.. 

do. 

Wagon. 
do. 



Wagon. 



Wagon. 

do. 

do. 



Wagon. 



446 



Results of bacterial counts of market milk in Washington, 1906 and 1907 — Continued. 



Name. 




Samples obtained at- 



25 


1907 


12 


1907 


12 


1907 


26 


1907 


12 


1907 


15 


1907 


23 


1907 


29 


1907 


9, 


1907 


22, 


1907 


5, 


1907 


13 


1907 


20 


1907 


28 


1907 


29, 


1907 


30 


1907 


30 


1907 


2, 


1906 


20 


1906 


21 


1906 


22 


1906 


23 


1906 


24 


1906 


18 


1907 


31 


1907 


5 


1907 


7 


1907 


13 


1907 


26 


1907 


8, 


1907 


14 


1907 


28 


1907 


8, 


1907 


6, 


1907 


15 


1907 


28 


1907 


11 


1907 


31 


1907 


26 


1907 


1 


1907 


19 


1907 


27 


1907 


22 


1907 


5 


1907 


19 


1907 


17 


1906 


18 


1906 


19 


1906 


20 


1906 


21 


1906 


13 


1907 


30 


1907 


15 


1907 



Tempera- 
ture of 
milk 

when ob- 
tained 
(°C). 


Number of 
bacteria 
per cubic 

centimeter. 


21 


330,000 


21 


370,000 


12 


320,000 


10.5 


65,000,000 


11.5 


21,400,000 


11 


10,000,000 


10 


1, 550, 000 


14 


5,500,000 


15.5 


36,000,000 


9 


5,300,000 


12 


2,800,000 


11 


50,000,000 


9.5 


3,700,000 


11.5 


7,000,000 


5 


15,500,000 


9 


101,000 


22 


1,300,000 


24 


60,000,000 


24 


307,800,000 


23 


80,000,000 


24 


4,000,000 


24 


1,000,000 


19 


9,800,000 


10 


1,880,000 


31 


2,860,000 


15 


480,000 


18 


2,440,000 


7 


12,800,000 


7 


1,900,000 


14 


58,000,000 


8 


5,000,000 


4.5 


1,400,000 


11 


31,200,000 


10.5 


1,410,000 


7 


182,000 


6 


700,000 


11.2 


4,000,000 


8.2 


23,000,000 


7 


440,000 


24 


75,000 


20 


700,000 


20 


2,000,000 


21 


800,000 


17 


106,000 


21.5 


2,030,000 


13 


4,400,000 


16.5 


2,200,000 


20 


6,100,000 


16 


33,150,000 


14.5 


12,860,000 


16 


4,270,000 


14 


4,700,000 


5 


1,600,000 



Ro. 



Ru. 



Sh. 



Sha. 
She. 

Shu. 

Si... 

Sm. 
Smo 



Sp. 



July 

Aug. 

July 

July 

Aug. 

Aug. 

Aug. 

Aug. 

July 

July 

Aug. 

Aug. 

Aug. 

Aug. 

Aug. 

Aug. 

July 
fAug. 

Aug. 

Aug. 

Aug. 

Aug. 

Aug. 

July 

July 

Aug. 

Aug. 

Aug. 
[Aug. 

July 

Aug. 

Aug. 

July 

Aug. 

Aug. 

Aug. 

July 

July 

Aug. 
[Aug. 

Aug. 
lAug. 

Aug. 
JJuly 
lJuly 
'Sept. 

Sept. 

Sept. 

Sept. 

Sept. 

July 

July 

Aug. 



Wagon 
....do. 



Dairy 

Sibley Hospital. 

Dairy 

Wagon 



Wagon. 
Dairy.. 
....do.. 
....do.. 
....do. 
....do. 
Wagon. 
....do. 
....do. 
....do. 
....do. 
....do. 
....do. 



Orphan Asylum. 

Wagon 

....do 

Dairy 

....do 



Dairy. 
....do. 



Dairy. 
....do. 
....do. 



Dairy.. 
....do. 
Wagon . 

do. 

....do. 

do.. 

do. 

....do. 

do. 

do. 

do. 

.....do. 
do. 



Wagon. 
Dairy.. 



447 

Results of bacterial counts of market milk in Washington, 1906 and 1907 — Continued. 



Name. 



Date. 



Samples obtained at- 



Tempera- 
ture of 
milk 
when ob- 
tained 
(°C). 



Number of 
bacteria 
per cubic 

centimeter. 



Spr. 



Spri. 



St. 



Su. 



Ta. 



Te. 



Th. 



Tr. 



Un.. 



July 31 
Aug. 6 
Aug. 24 
Aug. 27 
July 17 
Aug. 5 
Aug. 21 
Aug. 3 
[July 
July 26 
Aug. 6 
Aug. 15 
Aug. 23 
JAug. 8 
JAug. 14 
Aug. 30 : 
....do.. 
Aug. 31 
....do. 
July 12 
July 19 
July 22 
July 23 
Aug. 5 
Aug. 8 
Aug. 14 
[Aug. 16 
("July 12 
Aug. 8 
[Aug. 15 
(July 16 ; 
{Aug. 2 
Aug. 14 
Aug. 15 
Aug. 16 
Aug. 17 
Aug. 24 
July 11 
July 18 : 
July 24 
Aug. 13 
Aug. 26, 
Sept. 26 : 
Aug. 2, 
Aug. 13 
Aug. 21 
Aug. 23 
Aug. 27 
July 8 
July 22 
Aug. 7 
Aug. 16 



1906 
1906 
1906 
1906 
1907 
1907 
1907 
1906 
1907 
1907 
1907 
1907 
1907 
1906 
1907 
1906 



1906 



1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1907 
1906 
1906 
1906 
1906 
1906 
1907 
1907 
1907 
1907 
1907 
1906 
1907 
1907 
1907 
1906 
1906 
1907 
1907 
1907 
1907 



Wagon 
....do. 
Dairy. 
....do. 

Dairy. 
....do. 
Wagon 

Dairy.. 
Wagon 
Dairy. 
Wagon 
....do. 
Dairy. 
Wagon 
Dairy. 
Wagon 

Wagon 
....do. 
Dairy. 
....do. 

Dairy. 
....do. 
Wagon 
....do. 
....do. 
....do. 
....do. 
....do. 
....do. 

Wagon 
Dairy. 
....do. 
....do. 
....do. 
....do. 
....do. 

Dairy. 

Dairy. 
....do. 



20 
20 
20 
12 
23 
14 
11 
12 
13 
10 
11 
14 
8.5 
22 
15 



10 
15 
21 
11 

9.5 

7 

16.5 
13 

9 

9.5 

9.5 
15 
13 

22.5 
21 
17 
15 
24 
25 
24 
16 
11.5 
18 
10 
10 
13 
16 
23 
20 
12 
13 
13 

8 
11 



1,600,000 

9,580,000 

2,100,000 

9,000,000 

250,000 

22,000,000 

78,000,000 

260,000 

300,000 

940,000 

2,500,000 

200,000 

159,000,000 

44,400,000 

30, 000, 000 

14, 000, 000 

11,500,000 

42,000,000 

33,000,000 

2, 570, 000 

63, 000, 000 

87,500,000 

7,700,000 

650, 000 

2,000,000 

100,000,000 

42,000,000 

8,900,000 

2,050,000 

100,000,000 

640,000 

400,000 

1, 300, 000 

2, 400, 000 

4,800,000 

12,000,000 

15, 600, 000 

297,000 

57,000 

1,080,000 

100,000 

2,500,000 

420, 000 

1,190,000 

180,000 

4,200,000 

13,400,000 

28,200,000 

109,000 

182,000 

107,000 

5,000 



448 

Results of bacterial counts of market milk in Washington, 1906 and 1907 — Continued. 



Name. 



Date. 



Samples obtained at- 



Tempera- 

ture of 

milk 

when ob- 
tained 

(°C.). 



Number of 
bacteria 
per cubic 

centimeter. 



Va. 
Vi. 



Wa. 



Wal. 



Way. 



Wy. 



Average for 1906. 
Average for 1907. 



Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 
Aug. 



1, 1907 
8, 1906 
1, 1906 
2, 1906 
3, 1906 
6, 1906 
7, 1906 
8, 1906 
9, 1906 
10, 1906 
Aug. 11,1906 
Aug. 13,1906 
Aug. 14,1906 
Aug. 15,1906 
Aug. 16,1906 

....do 

Aug. 17,1906 
Aug. 20,1906 
Aug. 21, 1906 
Aug. 28, 1906 

....do 

Sept. 26, 1906 
July 19,1907 
July 24,1907 
Aug. 1,1907 
Aug. 13,1907 
Aug. 20,1906 
Aug. 21,1906 
Aug. 22,1906 
Aug. 23,1906 
Aug. 24,1906 
July 23,1907 
Aug. 14,1907 
Aug. 28,1907 
Aug. 29,1907 
Aug. 2,1906 
'July 15,1907 
July 19,1907 
Aug. 21,1907 
Aug. 26,1907 
Sept. 4,1907 
Sept. 5,1907 



Wagon. 

....do. 

do. 

do. 

do. 

....do. 

....do. 

....do. 

....do. 

do. 

do. 

do. 

do. 

do. 

do. 

do. 

do. 

do. 

do. 

do. 

....do. 

Dairy.. 



Wagon. 
Dairy.. 



Wagon. 

do.. 

do.. 

do.. 

do.. 



Dairy.. 

do.. 

do.. 

Wagon. 



Wagon. 

do.. 

do.. 

do.. 



24 
21 
18 
18 
19 
22 
21 
12 
15 
15 
16 
14 
14 
14 
19 
19 
14 
23 
18 
16 
16 
10 

9 
10.5 

4.5 

5.5 
22 
24 
23 
23 
22 

5 
11 
21 

8 
24 
15 
12 
18 

9 
17 

4 



16.5° C. 
14. 2° C. 



1,000,000 

105,000,000 

400,000 

3,200,000 

520,000 

200,000 

290,000 

156,000 

40,000 

55,000 

41,000 

48,000 

39,000 

80,000 

130,000 

134,000 

73,000 

108,000 

196,000 

86,000 

84,000 

2,100,000 

3,080,000 

340,000 

210,000 

160,000 

28,800,000 

238,000,000 

63,000,000 

119,000,000 

201,000,000 

70,500,000 

26,000,000 

2,800,000 

2,000,000 

31,800,000 

7,000,000 

6,250,000 

6,800,000 

590,000 

3,900,000 

10,300,000 



22,134,000 
11,270,000 



449 

BACTERIAL COUNTS IN OTHER CITIES. 

The great bacterial contamination of milk in other cities is given 
in order to compare with the results found in Washington. 

The statement is frequently made that the milk of American 
cities has fewer bacteria than that of European cities. The methods 
used for making bacterial counts differ, so that comparisons are dif- 
ficult to make. The larger cities have a much greater bacterial 
contamination in their general milk supply than the smaller cities 
and towns. We would expect this difference when we recall how 
much easier it is to obtain milk less than 24 hours old in villages and 
small towns. 

In comparing the following figures it must be remembered that in 
'some instances the milk is collected as it reaches the city, while 
in other instances, corresponding to our work in Washington, the 
samples were taken as they reached the consumer. Bacteria 
multiply enormously between the time the milk arrives in a city and 
the time it is delivered to the consumer. 

Von Geuns a in 1885 was the first to give us information concern- 
ing the number of bacteria contained in milk. He found 10,545 
bacteria per cubic centimeter in the so-called pasteurized milk sold 
in Amsterdam. 

Clauss, & 1889, made eight examinations of the fresh dairy milk of 
Wiirzburg in the winter of 1888-89 and found the average bacterial 
content to be between 1,000,000 and 2,000,000, the lowest count 
being 222,000 and the highest 2,300,000. The author says that 
Hohenkamp c in the summer, in Wiirzburg, found the bacterial con- 
tent to range between 1,900,000 and 7,200,000 per cubic centimeter. 

Cnof, d 1889, working with Escherich, found in the milk of Munich, 
as it came to the hands of the consumer five to six hours after the 
milking, that the bacterial content ranged between 200,000 and 
6,000,000 per cubic centimeter; a few moments after milking the 
number ranged between 60,000 and 100,000 per cubic centimeter. 

Renk,* 1891, found between 6,000,000 and 30,700,000 bacteria per 
cubic centimeter in the milk supply of Halle. Further, from a series 
of 30 tests it was found that an average of 15 milligrams of cow's 

° Von Geuns, J.: Ueber die Einwirkung des sog. " Pasteuricirens" auf die Milch. 
Arch. f. Hyg., vol. 3, 1885, p. 464. 

b Clauss, Johannes: Bacteriologische Untersuchungen der Milch im Winter 1888- 
89 in Wurzburg mit besonderer Beriicksichtigung der Milchsaure Bildenden Bac- 
terien. Inaug. disserta., Wurzburg, 1889. 38 p. 8°. 

c Hohenkamp: Arch. f. Hyg., vol. 14, p. 260. 

d Cnof: Quantitative Spaltpilzuntersuchungen in der Kuhmilch. Cent. f. Bakt., 
vol. 20, 1889, p. 553. 

e Renk: Ueber Martmilch in Halle. Munch, med. Woch., 1891. Rev. by Esche- 
rich, Cent. f. Bakt., vol. 10, 1891, p. 193. 
45276°— Bull. 56—12 29 



450 

excrement per liter was contained in the milk supply of Halle ; Leipzig, 
3.8 milligrams; Berlin, 10.3 milligrams, and Munich, 9 milligrams. 

Uhl a in 1892 showed the great fluctuation in the bacterial content 
of the milk of Giessen. In May, 1892, from 30 examinations he found 
it ranged between 83,000 and 169,600,000; in June the lowest count 
was 10,500 and the highest 13,600,000. The average in May was 
22,900,000, and the average in June was only 2,900,000. 

Sedgwick and Batchelder, 6 1892, were the first to record the bacterial 
content of milk from an American city. From a series of examina- 
tions of the milk supply of Boston and its suburbs they report as 
follows : 



City. 


Samples. 


Bacteria 
per cubic 
centimeter. 


City. 


Samples. 


Bacteria 
per cubic 
centimeter. 


Charleston 


8 
9 
10 


4,222,500 
2,778,000 
3,259,600 


Roxbury 

North End 


17 
6 

7 


1,874,300 

708, 100 

1,189,800 













These samples were taken directly from the milk wagons and 
planted at once. 

From groceries 16 samples additional were taken which averaged 
4,577,000 bacteria per cubic centimeter. 

Ten samples collected from well-to-do families averaged 1,438,000 
bacteria per cubic centimeter. 

Forty-four samples of the so-called "railroad" milk from one 
dealer averaged 500,000 per cubic centimeter. The extremes were 
5,664,000 and 2,200. 

Another set of ten samples examined on arrival in Boston averaged 
371,000 per cubic centimeter. 

Knochenstiern c in 1893 gives the results of examination of milk at 
Dorpat, Russia, between September 18 and January 25, as follows: 

Average bac- 
teria per 
cubic cent- 
imeter. 

From milkmen 10, 200, 000 

Village milk 12, 000, 000 

Market milk 25, 000, 000 

Shop milk 30, 000, 000 

a Uhl: Untersuchungen der Martmilch in Giessen. Zeit. f. Hyg., vol. 12 : 1892, p. 475. 

& Sedgwick and Batchelder: A bacteriological examination of the Boston milk sup- 
ply. Boston Med. and Surg. Journ., vol. 126, 1892, p. 25. 

c Knochenstiern, Hugo: Ueber dem Keimgehalt der Dorpater Martmilch nebst 
einigen bacteriologischen Untersuchungen von Frauenmilch. Inaug. Disserta., 
Dorpat. 1893. 51 p. 8°. 



451 

The same author gives abstracts of findings by the following 
authors : 



Author. 



Buiwid (16 examinations) 

Genus (dairy milk) 

Cunningham, D. (1891) . . . 



City. 



Warsaw 

Amsterdam 
Calcutta 



Average bacteria 
per cubic centi- 
meter. 



4,000,000 

2,500,000 

3, 400 to 3, 000, 000 



Rowland, 1895, found the average bacterial content of 25 sam- 
ples of milk in London to be 500,000 per cubic centimeters. 

Frye b in 1896 examined nine samples of milk in Buffalo as it was 
delivered to the consumer from December 28, 1895, to June 11, 1896, 
and found the bacterial content to range from 48,000 to 43,600,000 
per cubic centimeter. 

In six samples of grocery milk examined from January 26 to June 
11, 1896, the bacterial content ranged between 25,000 and 25,000,000 
per cubic centimeter. 

In seven samples of "certified milk" the bacterial content ranged 
between 4,400 and 132,700 per cubic centimeter. 

Pakes c in 1900 states that London's milk supply contains between 
3,000,000 and 4,000,000 bacteria per cubic centimeter. 

Park, d 1901, found the milk in New York City to contain, as a 
rule, excessive numbers of bacteria. During the coldest weather 
the milk in the shops averages over 300,000 bacteria per cubic centi- 
meter, during cool weather about 1,000,000, and during the hot 
weather about 5,000,000. He found the condition of the average 
city milk very different, depending upon temperature and other 
conditions. The milk as it is received in New York from the rail- 
roads averages over 5,000,000 bacteria per cubic centimeter, the 
lowest count being 52,000 and the highest 35,200,000. 

Burrage e in 1901 states that American cities appear to have better 
milk from a bacterial standpoint than European cities. In the latter, 
milk seldom contains less than 5,000,000 bacteria per cubic centi- 
meter. In the milk supply of Middletown, Conn., the number of 

o Rowland, Sidney D. : Report of 25 samples of milk examined as to their bacterial 
flora. Brit. Med. Journ., 1895, vol. 2, p. 321. 

& Frye, Maud J.: Notes upon the estimation of the number of bacteria in milk. 
Med. Rec, 1896, vol. 2, p. 442. 

c Pakes, Walter: The application of bacteriology to public health. Lancet, 1900, 
vol. 1, p. 311. 

d Park, W. H.: The great bacterial contamination of the milk of cities, can it be 
lessened by the action of health authorities? Journ. Hyg., vol. 1, 1901, r p. 391. 

e Burrage, Severance: Some sanitary aspects of milk supplies and dairying. Iowa 
Board Health, Eleventh Bien. Rep., 1901, p. 373. 



452 



bacteria was found to be comparatively low, the milk being deliv- 
ered to the consumer within a few hours after milking. The bacte- 
ria varied from 11,000 to 300,000 per cubic centimeter. 

Goler, a 1903, states that prior to 1900 the average bacterial counts 
of 86 samples of Rochester, N. Y., milk showed 837,000 per cubic 
centimeter, excluding 26 per cent of the samples which contained 
over 5,000,000 bacteria per cubic centimeter. 

Dodd, 6 1904, gives the following: 



District. 


Standard of 
shop. 


Average 
bacteria 
per cubic 
centi- 
meter. 


District. 


Standard of 
shop. 


Average 
bacteria 
per cubic 
centi- 
meter. 


City of London 


Good class 

.do 


4,800,000 
1,600,000 
4,800,000 




Good class 

do 


1,600,000 
2,300,000 
3,200,000 






do 


Do 


Poor class 









Byrnes/ 1904, speaking of milk inspection in Philadelphia, says: 
" Another branch of this subject is the almost incredible number of 
bacteria found in our milk supply, which vary from 1,600 to 21,000,000 
per cubic centimeter." 

Jordan,** 1904, found that the market milk of Chicago contained 
an average of 9,361,000 bacteria per cubic centimeter in April, 
10,071,000 in May, and 18,924,000 in June, 1904. Sixteen per cent 
of the samples examined contained over 20,000,000 bacteria per cubic 
centimeter. 

Bergey, € 1904, found as a result of the examination of ten samples 
taken at random from a large series of examinations made in July, 
1900, from milk taken at railroad depots in Philadelphia, an average 
bacterial content of 4,802,355 per cubic centimeter. The author 
gives a table showing the reported average bacterial content per cubic 
centimeter of the milk in other American cities, as follows: 

Bacteria per 
cubic cen- 
timeter. 

New York 4, 000, 000 

Boston 2, 300, 000 

Chicago 2, 350, 000 

Baltimore 4, 000, 000 

Wilmington 7, 000, 000 

a Goler, George W. : The influence of the municipal milk supply upon the deaths 
of young children. N. Y. State Journ. Med., vol. 3, 1903, p. 493. 

b Dodd, F. Lawson: The problem of the milk supply. London, 1904. 77 p. 8°. 

c Byrnes, W. J.: Annual report of the chief inspector of milk for the year 1903. 
Philadelphia Bur. Health, Ann. Rep., 1903, p. 76. 

d Analyses of Chicago Market Milk, a report by the health and sanitation co mm ittee 
of the Civic Federation of Chicago, 1904. 

« Bergey, D. H.: Sanitary supervision of the collection and marketing of milk. 
Univ. Pa. Med. Bull., vol. 17, 1904, p. 187. 



453 

He says that European market milk has been found to contain a 
greater average bacterial count, ranging from 5,000,000 to 10,000,000, 
and frequently 20,000,000 to 180,000,000. 

Proskauer, Seligmann, and Croner, a 1907, found that Danish milk 
sold in Berlin in the summer varied, in round numbers, between 
5,000,000 bacteria per cubic centimeter and innumerable quantities. 
In the winter this milk contained about 2,140,000 bacteria per cubic 
centimeter. 

The same investigators found that the market milk of Berlin 
averaged 3,500,000 bacteria per cubic centimeter in summer and 
567,000 in winter. 

Knox and Schorer, 6 1907, state that several summers ago the quality 
of the milk supplied to the working classes in Baltimore was studied 
during two successive summers at the laboratory of the Thomas 
Wilson Sanitarium. Much of the milk on sale at the small stores 
was shown to be unfit for consumption, having a high bacterial count. 

It will thus be seen that the general market milk of Washington, 
as well as that of other large American and European cities, is worthy 
the serious attention of health officers so far as excessive bacterial 
contamination is concerned. 

Addenda. — At the last meeting of the American Association of 
Medical Milk Commissions the following report of the committee on 
bacteriological standards for certified milk was adopted : 

The methods, so far as applicable, shall be those recommended by the committee 
on standard methods of bacteriological milk analysis of the laboratory section of the 
American Public Health Association. 

Bacterial counts for certified milk should be made at least once a week. 

Use agar-agar made according to the recommendation of the committee of the 
American Public Health Association containing 1.5 per cent agar and a reaction of 
+1.0 to phenolphthalein. 

Grow at 37° C. for forty-eight hours, or at 22° C. for five days, or 27° C. for three days. 

When in bottles, milk samples should be obtained in original packages and brought 
direct to the laboratory unopened. 

As soon as practicable upon arrival at the laboratory, open the bottle with aseptic 
precautions and thoroughly mix the milk either by pouring back and forth between 
the original bottle and a sterile bottle, or by agitation for two minutes. 

Make no less than two plates for each sample. 

Make a control of each lot of medium and apparatus at each testing. 

Dilute the milk in the proportion of 1 part of milk to 99 parts of sterile water; shake 
25 times and plate 1 cubic centimeter of the dilution. 

Express results in multiples of the dilution factor. 

a Proskauer, B., Seligmann, E., and Croner, Fr.: Uber die Beschaffenheit der in 
Berlin eingefuhrten danischen Milch. Ein Beitrag zur hygienischen Milchkontrolle. 
Zeit. f. Hyg., vol. 57, 1907, p. 173-247. 

& Knox, J. H. Mason, and Schorer, Edwin H.: A study of hospital and dispensary 
milk in warm weather; with special reference to pasteurization. Arch. Pediatrics, 
July, 1907. 



12. THE GERMICIDAL PROPERTY OF MILK. 



(455) 



THE GERMICIDAL PROPERTY OF MILK. 



By Milton J. Rosenau, Director Hygienic Laboratory, Public Health and 
Marine-Hospital Service; and George W. McCoy, Passed Assistant 
Surgeon, Public Health and Marine-Hospital Service. 



INTRODUCTION. 

Judged by the number of colonies that develop upon agar plates, 
the bacteria in milk first diminish then increase in number. This 
occurs only in raw milk during the first few hours after it is drawn. 
Although the bacteria seemingly decrease in number, they never dis- 
appear entirely. After this initial decrease there is a continuous and 
rapid increase until the milk contains enormous numbers. 

It was early noted that under certain conditions raw milk may keep 
longer than heated milk. In other words, the property of milk to 
restrain the growth of bacteria is destroyed by heat. 

Before this so-called " germicidal property of milk " was discovered 
it had been observed that fresh blood, or blood serum, had distinct 
powers of destroying bacteria. Further, that blood resists putrefac- 
tive and fermentative changes. It is now well known that blood, 
apart from the phagocytic action of its cells, has definite germicidal 
properties. This is due to substances in solution in the blood serum 
which have the power of clumping, killing, or dissolving the bacterial 
cells. This power of the blood is an important protection against 
bacterial invasion. Similar uses have been assigned to the " anti- 
bodies " in milk. The germicidal properties of blood are destroyed 
by heat and disappear spontaneously in a short time after it has been 
removed from the body. 

Not only the blood, but other body fluids have germicidal properties 
in varying degree, so that it was not surprising when similar powers 
were attributed to milk, especially when we consider that the fluid 
part of milk, with many of its constituents, is secreted directly from 
the blood. 

This initial power of milk to destroy bacteria or to restrain their 
multiplication is feeble and variable. The germicidal properties of 
milk have been much misunderstood, especially by dairymen, some 

(457) 



458 

of whom insist that advantage may be taken of this property for the 
preservation of milk without the use of ice. 

When we stop to consider that bacteria frequently enter the imper- 
fectly closed orifice of the teat and grow in the milk contained in 
the milk cisterns, and that they often invade the finer tubules of the 
gland structure where the milk is being freshly secreted, we must 
be convinced that the " germicidal " power of milk must be exceed- 
ingly feeble, if it exist at all. 

This property varies with the milk of different animals, and also 
in the milk of the same animal at different times. 

There, is evidence to show that the restraining action of fresh raw 
milk upon the growth of bacteria varies with the bacterial species, 
and when we inquire into the causes of the phenomenon we find that 
this is what we might expect. 

When micro-organisms are transferred to a strange medium they 
sometimes hesitate, until they become sufficiently accustomed to the 
new surroundings, before they begin to multiply. Our experiments 
show that this is by no means always the case and can not account 
for the facts now under consideration. 

We know that the serum of milk may contain " antibodies " in 
appreciable and variable quantity similar to those found in the 
blood. For instance, diphtheria, tetanus, and other antitoxins have 
been demonstrated in the milk of immunized animals. We might 
also expect small quantities of the agglutinating, bactericidal, and 
bacteriolytic substances present in blood serum to pass into the milk 
serum. Agglutinins in milk would apparently diminish the number 
of bacteria contained therein when estimated by the number of 
colonies that develop on agar plates. This might occur even though 
the number of bacteria present were actually increased. Microscopic 
examination of the bacteria in milk made at once after milking, and 
again in eight hours, demonstrates that such agglutination actually 
takes place. This is confirmed by our other technique. 

We know that milk always contains large numbers of leucocytes — 
many of them of the polymorphonuclear variety. These are known 
to be phagocytes, and we might assume that they are active in milk 
for a short time after it is drawn. In fact we have found that some 
of the leucocytes actually contain more bacteria after eight hours 
than when the milk is freshly drawn. 

If phagocytosis played a part in the diminution in the number of 
bacteria in milk, we must assume that the milk serum has opsonic 
power. ffl Our work shows that phagocytosis plays no essential role 
in the apparent reduction in the number of bacteria in fresh milk. 

a In fact Woodhead and Mitchell claim to have demonstrated opsonins in milk. 
Journ. of Path, and Bactr., vol. 11, 1906-7, p. 408. 



459 

It seems likely that the germicidal property of milk corresponds to 
a similar property of fresh blood serum. This makes it probable that 
the causes are numerous and complex. Further, it explains why the 
action is variable in different milks and in milk from the same animal 
at different times. It also gives us a clew as to why the action is to 
a certain extent specific. 

Although the germicidal property of fresh milk is feeble, it must 
be of value to the suckling. This self-evident fact emphasizes the 
importance of using fresh milk for artificial feeding. 

EXAMPLES OE THE GERMICIDAL ACTION. 

The following examples show that milk when fresh and raw actu- 
ally restrains the growth of bacteria as judged by the development 
of colonies upon agar plates. Whether the bacteria are restrained, 
destroyed, or clumped is not evident from such technique. 

This series shows the effect upon the growth of the bacteria that 
usually contaminate milk. These results show a restraining, rather 
than a germicidal action, which varies with the temperature. Actual 
reduction in numbers is more apparent from a study of our work with 
pure cultures (vide infra). 

Table No. 1. — Milk from a healthy cow (No. 1). 
[Immediately after milking contained 400 bacteria per cubic centimeter.] 





Bacteria per cubic centimeter at different 
temperatures. 


Time after milking. 


Room temper- 
ature, 16° to 
23° C 


15° C. 


37° C. 


2 hours 


430 

100 

350 

450 

500 

400 

500 

5,000 

60, 000 

366,000 

780,000 

24,200,000 

250,000,000 

330,000,000 

910,000,000 

Sour. 








450 

600 

300 

350 

300 

400 

2,000 

2,000 

1,000 

3,800 

61,000 

118,000 

3, 080, 000 

33,400,000 

192,000,000 

Innumerable. 


350 


6 hours 


2,100 

345,000 

1, 780, 000 

32,800,000 

75, 500, 000 




10 hours 




14 hours 


24 hours 


36 hours 




48 hours 




60 hours 




72 hours 








96 hours 




108 hours 




120 hours 















460 



Table No. 2. — Milk from a healthy cow (No. 1). 
[Immediately after milking contained 500 bacteria per cubic centimeter.] 





Bacteria per cubic centimeter at different 
temperatures. 


Time after milking. 


Room temper- 
ature, 26° to 
29° C. 


15° C. 


37° C. 




1,300 

700 

400 

7,800 

29, 000 

340, 000, 000 

Innumerable. 

Sour. 








900 

500 

600 

1,200 

80,000 

1,380,000 

89,000,000 

Sour. 


11,300 
38,000 


6 hours 


8 hours 


342, 000 


10 hours 


50, 000, 000 


24 hours 


Sour. 






72 hours 




96 hours 











Table No 3. — Milk from a healthy coiv (No. 1). 
[Immediately after milking contained 8,300 bacteria per cubic centimeter.] 



Time after milking. 


Bacteria per cubic centimeter at various 
temperatures. 


Room, 26° to 
29° C. 


15° C. 


37° C. 




8,000 
2,000 

6,000 






3 hours 


2,000 


2,000 








2,000 
1,000 






2,000 
1,000 
1,000 


6,000 
20, 000 




8 hours 


5,000 


166, 000 







THE EFFECT OF TEMPERATURE. 

Temperature has a decided influence upon this phenomenon. 
When the milk is kept warm (37° C.) the decrease in the number 
of colonies is striking, but of short duration. When the milk is kept 
cool (15° C.) the decrease is less marked, but more prolonged. This 
is well illustrated by the curves, Figs. 9 to 14. 

These curves were plotted from the following tables, which show 
the germicidal properties of milk for individual species of bacteria. 
The experiments were conducted as follows : 

Milk was obtained from a healthy cow, using particular care to 
prevent outside contamination. For this milk we are greatly indebted 
to Doctor Schroeder and Mr. Cotton, of the Experiment Station, 
Department of Agriculture, Bethesda, Md. 

In addition to the usual precautions, a cloth wet with bichloride 
solution was placed under the cow, permitting only the teats to pro- 



461 



ject through. The foremilk was discarded and about 10 to 15 cubic 
centimeters of the midmilk was introduced directly into sterile test 
tubes. Some of these tubes, tested soon afterwards, were found to 
be practically sterile; other contained about 60 bacteria per cubic 
centimeter. Without delay, a loopful of a pure culture of the 
organism to be tested from a 24-hour-old agar slant was placed in 
the tubes of the freshly drawn milk. Two of the tubes were con- 
taminated with each culture tested; one of them was kept at 15° C. 
and the other at 37° C. 

For a control, a similar loopful of culture was planted in a tube 
of whole milk that had been sterilized fractionally upon three suc- 
cessive days. At the intervals shown in the tables the tubes were 
shaken in order to obtain a uniform suspension, and a loopful planted 
upon agar by the plate method. Duplicate plates showed that the 
loop always took up about the same quantities. The results, how- 
ever, do not pretend to mathematical accuracy, but are sufficiently 
consistent to show any marked increase or diminution in the number 
of colonies. 

Table No. 4. — B. typhosus. 





Number of bacteria per loop — 


Milk from healthy cow (No. 2). 


At 15° C. 


At 37° C. 




In raw 

milk. 


In steril- 
ized 
milk. 


In raw 
milk. 


In steril- 
ized 
milk. 


At once, after milking 


6,720 
6,100 
5,940 
7,920 
1,860 
4,620 
3,180 
4,200 
(a) 


10,400 
10,180 
15,000 
20,000 
20,000 
11,000 
37,500 
31,000 
(a) 


6,580 

4,300 

985 

388 

62 

480 

1,800 

(a) 


4,860 
6,600 
15, 360 




4 hours later 


6 hours later 


(a) 

(a) 


8 hours later - 


10 hours later 


(a) 


12 hours later 


(a) 
(a) 


24 hours later 













a Innumerable. 

Here it was plain that there was an actual diminution in the num- 
ber of typhoid colonies from the tube kept at 37° C. during the first 
eight hours, after which multiplication began. The bacteria in the 
sterilized milk used as a control increased almost from the start. At 
15° C. the restraining effect is similar, but less pronounced and more 
prolonged. 



462 

Table No. 5. — B. dysenteriw. 





Number of bacteria per loop — 


Milk from healthy cow (No. 2). 


At 15° C. 


At37°C. 




In raw 
milk. 


In steril- 
ized 
milk. 


In raw 
milk. 


In steril- 
ized 
milk. 




2,820 
1,380 

900 
756 
890 
660 
540 
121 
109 
50 
55 


3,960 
3,800 
4,200 
4,400 
6,360 
8,040 
9,600 
15,000 
(a) 


4,680 

1,000 

720 

540 

348 

1,296 

7,200 

15,000 

(a) 


27, 000 




15, 000 




27,000 
(a) 

(a) 
(a) 

(a) 
(a) 














72 hours later 





















Innumerable. 



This shows the same phenomenon as in the case of the typhoid 
bacillus, excepting that the restraining power of the raw milk at 15° 
C. is more marked and prolonged for the dysentery bacillus. 

Table No. 6. — B. lactis wrogenes. 





Number of bacteria per loop— 


Milk from healthy cow (No. 2). 


At 15° C. 


At 37° C. 




In raw 
milk. 


In steril- 
ized 
milk. 


In raw 
milk. 


In steril- 
ized 
milk. 




19,920 
14,220 
15,120 
16, 680 
10, 980 
12,450 
9,720 
9,440 
(a) 


8,500 
9,600 

6,800 

7,560 
10, 000 
10,000 

(a) 

(a) 


16,000 
24,000 

7,750 
1,200 
418 
1,335 
4,500 
(a) 


23,000 

57,500 




4 hours later 


6 hours later 










12 hours later 




24 hours later 




48 hours later 













° Innumerable. 

This organism is one of the common causes of lactic acid fermenta- 
tion. It is practically always present in milk unless drawn with 
extraordinary precautions. It is evident that this particular sample 
of raw milk exerted the same temporary restraining influence upon 
this organism that it did upon the pathogenic species. 



463 



Table No. 7. — V. cholerw. 



Milk from healthy cow (No. 2). 



At once, after milking 

2 hours later 

4 hours later 

6 hours later 

8 hours later 

10 hours later 

12 hours later 

24 hours later 

48 hours later 

72 hours later 

96 hours later 



Number of bacteria per loop- 



At 15° C. 



In raw 
milk. 



2, 820 

740 

1,440 

1,740 

1,800 

820 

1,010 

1,440 

900 

6,700 

3,000 



In steril- 
ized 
milk. 



3,540 
7,860 
4,980 
5,100 
5,280 
7,200 
9,300 
16, 000 
(a) 



At 37° C. 



In raw 
milk. 



6,000 

6,720 

987 

1,711 

6,300 

11,880 

15, 660 

(a) 



In steril- 
ized 
milk. 



15,795 

(«) 
(a) 

(a) 
(a) 
(a) 



Innumerable. 



The milk had practically the same power of restraining the cholera 
vibrio that it had for the other bacteria tested. 

Table No. 8. — B. diphtheriw. 





Number of bacteria per loop — 


Milk from healthy cow (No. 2). 


At 15° C. 


At 37° C. 




In raw 
milk. 


In steril- 
ized 
milk. 


In raw 
milk. 


In steril- 
ized 
milk. 


At once, after milking 


270 
30 
230 
270 
330 
600 
200 
145 


160 
230 
430 
160 
300 
120 
180 
245 


470 
333 
285 
265 
275 
150 
215 


170 


2 hours later 


1,180 






6 hours later 


370 




960 


10 hours later 


2,700 


12 hours later 


3,800 


24 hours later 


8,420 


48 hours later 




(a) 











" Innumerable. 



The results obtained with the diphtheria bacillus are perhaps not 
quite so graphic as with the other organisms, partly for the reason 
that the diphtheria bacillus is not motile and it is difficult to obtain 
a uniform suspension ; and also partly for the reason that it grows so 
slowly, if at all, at 15° C. However, at 37° C. definite restraining 
action is evident in the raw milk as compared with the sterilized milk. 



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470 

RELATION TO AGGLUTINATION. 

Agglutination of bacteria in milk is somewhat difficult to demon- 
strate macroscopically. Under the microscope, in stained prepara- 
tions, the bacteria are in large and dense clusters in raw milk after 
standing eight hours at 37° C. In the boiled milk used as a control 
the bacteria under the same conditions appear singly or in very short 
chains or small clumps. In our work care was taken to break up all 
clumps in the suspensions used to inoculate both the raw and the 
boiled milk. 

Vigorous shaking also gave results that plainly proved that 
agglutination is one of the factors that cause an apparent decrease 
in the number of bacteria. 

The agglutinated bacterial clusters were broken asunder by one or 
both of the following methods, stated in each table : 

1. Vigorous shaking of the milk for about five minutes in a glass- 
stoppered cylinder. 

2. Drawing the suspension in and out a number of times through a 
capillary pipette, the end of which is broken off square and closely 
applied to the bottom of a test tube. 

Table No. 9. — Milk from healthy cow (No. 2) inoculated one and one-half hours 

after milking. 

[Organisms from 24-hour agar cultures. Controls, same milk heated to boiling.] 



Colonies per 
loop at once 
after inocu- 
lation. 



Colonies per 
loop after 8 

hours at 
37° C. mod- 
erate shak- 
ing. 



Colonies per 
loop after 8 

hours at 
37° C after 
vigorous agi- 
tation and 
mixing with 
pipette. 



B. typhosus in raw milk 

B. typhosus, control 

Staphylococcus pyogenes aureus in raw milk 

Staphylococcus pyogenes aureus, control 

B. coli in raw milk 

B. coli, control 

Original milk 

a Innumerable. 



5,620 
9,540 
4,660 
4,850 
2,600 
8,100 
17 



2,640 

obi, 000, 000 

3,810 

a b 200, 000 

9,720 

a b 1, 500, 000 

45 



9,720 



5,610 
a b 100, 000 



b About. 



Table No. 10. 



471 



-Milk from healthy cow (No. 2) inoculated one and one-half hours 
after milking. 



L Controls, same milk heated in Arnold sterilizer to 100° C. for ten minutes, 
used were from 24-hour agar cultures.] 



Organisms 



Bacteria per 
loop at once. 



Bacteria per 
loop after8 
hours at 37° 

C, tube 

moderately 

shaken. 



Bacteria per 

loop after 8 

hours at 37° 

C, culture 

vigorously 

agitated 5 

minutes and 

mixed with 

a pipette. 



B. lactis aerogenes in raw milk 

B. lactis aerogenes, control 

B. typhosus in raw milk 

B typhosus, control 

Staphylococcus pyogenes aureus in raw milk. 

Staphylococcus pyogenes aureus, control 

Original milk 



1,200 
1,200 
3,440 
2,160 
2,120 
2,660 



4,400 
(a) 

4,107 
(a) 

1,220 
30,000 



14, 000 



7,560 
2,070 



a Innumerable. 



The next experiment was designed to show whether the phenome- 
non of germicidal action could not be duplicated by the addition of 
typhoid agglutinating serum to milk that had been boiled. 



Table No. 11. — Milk from healthy cow (No. 2) planted one and one-half 'hour, 

after milking. 

[Controls, same milk boiled — 24-hours old agar culture used.] 





Bacteria 
per loop 
at once 
after in- 
oculation. 


Bacteria 
per loop 
after 2£ 
hours at 
37° C 


Bacteria 
per loop 
after 4£ 
hours at 
37° C 


Bacteria 
per loop 
after 6i 
hours at 
37° C 


Bacteria per loop after 
8£ hours at 37° C 




Moder- 
ately 
shaken. 


Mixed 

with 

pipette. 


B. typhosus in raw milk 


1,880 


1,380 


1,060 


1,480 


1,980 


12, 200 


B. typhosus in same milk 














boiled (control) 


2,120 


4,020 


a b 800, 000 


(a) 


(a) 


(a) 


B. typhosus in raw milk plus 




1 drop typhoid serum 


2,100 


2,040 


1,920 


2,360 


1,260 


a b 20, 000 


B. typhosus in boiled milk 














plus 1 drop typhoid serum. 


2,280 


2,360 


7,020 


6,480 


10, 860 


a b 60, 000 


B. typhosus in bouillon plus 














1 drop typhoid serum 


1,830 


970 


2,920 


9,180 


11, 160 


a 6 100,000 


Original milk 





1 


2 


2 


2 


46 







a Innumerable. 



6 About. 



The typhoid serum used in this experiment was a strongly agglu- 
tinating horse serum (strength over 1 : 10,000). 

It will be seen that boiled milk plus typhoid agglutinin acts much 
the same as the raw milk. The contrast in each case with the con- 
trol (boiled milk) is striking. 



472 

The fact that agglutination plays a prominent role in this phe- 
nomenon is well illustrated in this table by the fact that the bacterial 
clumps may be shaken apart. This was confirmed by the micro- 
scopic examinations of stained smears in each case. 

Table No. 12. — Milk from healthy cow (No. 2). 
[Plantings one hour after milking.] 



Bacteria 
per loop 
at once 
after in- 
oculation. 



Bacteria 
per loop 

after 

3 hours at 

37° C 



Bacteria 
per loop 

after 

5 hours at 

37° C. 



Bacteria per loop after 
7 hours at 37° C. 



Moder- 
ately 
shaken. 



Mixed 

with 

pipette. 



B. typhosus in raw milk 

B. typhosus in boiled milk 

48-hour B. coli culture in raw milk 
Original milk 



5,400 

6,400 

16,000 

2 



4,680 
5,040 
12,000 

1 



4,720 

a b 100, 000 

11,000 

2 



2,250 

a b 200, 000 

9,000 

3 



5,400 

i b 200, 000 

a b 40, 000 

112 



a Innumerable. "About. 

Table No. 13. — Milk from healthy cow (No. 2). 

L Plantings one hour after milking.] 





Bacteria 
per loop 
at once 
after in- 
oculation. 


Bacteria 
per loop 

after 

3 hours at 

37° C 


Bacteria 
per loop 

after 

5 hours at 

37° C. 


Bacteria per loop after 
7 hours at 37° C. 




Moder- 
ately 
shaken. 


Mixed 

with 

pipette. 


1 loop faeces and hay emulsion in raw milk . 
1 drop f aeces and hay emulsion in raw milk . 
5 drops faeces and hay emulsion in raw 


720 
4,860 

10,500 


660 
4,640 

7,500 


480 
6,000 

9,900 


420 
3,780 

13,000 


4,320 
9,720 

20,000 





Table No. 14. — Milk from healthy cow (No. 2) planted, one and one-half hours 

after milking. 

[Controls same milk boiled.] 



Bacteria 
per loop 
at once 
after in- 
ocula- 
tion. 



Bacteria 
per loop 
after 1\ 
hours at 
37° C 



Bacteria 
per loop 
after 4£ 
hours at 
37° C 



Bacteria 
per loop 

after 6£ 
hours at 

37° C 



Bacteria per loop 

after 8£ hours at 
37° C 



Moder- 
ately 
shaken. 



Mixed 

with 

pipette. 



1 drop cow faeces and hay suspension in 

raw milk 

1 drop cow faeces and hay suspension in 

boiled milk (control) 

4 drops cow faeces and hay suspension in 

raw milk 

4 drops cow faeces and hay suspension in 

boiled milk (control) 

Original milk 



18 
124 



26 

80 

450 

720 
2 



44 

1,260 

1,800 

3,300 
2 



5,400 



473 

The fact that bacterial clusters may be separated by shaking, etc., 
is still more convincingly demonstrated in many of the other tables 
throughout the remainder of this article. 

THE GERMICIDAL ACTION COMPARED WITH THAT OF BLOOD 

SERUM. 

For the purpose of comparison the following experiment was made 
with fresh blood serum. The blood was drawn from the jugular 
vein of a horse, defibrinated and centrifugated for fifteen minutes 
at 1,800 revolutions per minute. In this way a fresh serum free from 
fibrin and cellular elements was quickly obtained. Care was exercised 
throughout the process to avoid contamination. 

The serum was now divided into two portions: (1) Untreated, 
and (2) heated to 60° C. for twenty minutes. This temperature 
was selected as being sufficient to destroy the bacteriolytic property 
without seriously interfering with the agglutinins. 

The heated and the unheated serum was now inoculated with 
24-hour-old cultures from agar slants. The bacillary emulsion was 
first drawn in and out of a pipette in order to break up clumps. 





Bacteria per loop — 




At once 
after in- 
ocula- 
tion. 


After 2 

hours at 

37° C. 


After 4 

hours at 

37° C. 


6 hours at 37° C. 


After 24 

hours at 

37° C 




Moder- 
ately 
shaken. 


Mixed 
with a 
pipette. 


B. typhosus in fresh horse serum 

B. typhosus in fresh horse serum, heated 
to 60° C 20 minutes 


3,240 

2,700 
1,500 

2,640 


328 

2,650 

5 

3,180 


364 

7.600 


9,000 


220 

ob 70, 000 


a&100,000 


636 

o&250,000 


o&200,000 


11,000 

(a) 
5,400 

(o) 


B. lactisaerogenes in fresh horse serum. . 

B. lactis aerogenes in fresh horse serum, 

heated to 60° C. 20 minutes 





a Innumerable. 



6 About. 



It is at once evident that there is a general resemblance between 
blood serum and milk so far as this phenomenon is concerned. It is 
also plain that blood has a much quicker and stronger action than 
milk. 

The results of the bacterial counts upon agar plates were confirmed 
by microscopical examination of stained smear preparations. At 
first the organisms were well distributed throughout the serum, 
whether heated or unheated. There were no clumps of over six or 
eight individuals. 

At the end of six hours no organisms could be found under the 
miscroscope in preparations made from the unheated serum planted 
with B. lactis aerogenes. Only occasionally could the typhoid bacil- 



474 

lus be discovered in the corresponding serum at the end of six hours. 
This agrees with the number of colonies upon the agar plates. 

The heated serums gave quite a different picture under the micro- 
scope. Many organisms were found, lying singly, in small and long 
chains, and in dense clusters. This corresponded to the innumerable 
growth upon the agar plates. 

RELATION TO PHAGOCYTOSIS. 

Milk contains many leucocytes and it therefore seems reasonable 
to assume that active phagocytosis takes place in the fresh raw prod- 
uct. A priori it seemed to us that this might account for the germi- 
cidal property of milk. This assumption was apparently confirmed 
when we found that stained smear preparations showed but few if 
any bacteria in the cells in the fresh milk just after inoculation with 
bacterial cultures, while similar preparations made from the same 
milk eight hours later, kept at 37° C, showed numerous bacteria in 
some of the cells. 

The following experiments, however, demonstrate that the ger- 
micidal power of milk is independent of its cellular contents. The 
leucocyte-free milk is quite as active as the leucocyte-rich sediment 
obtained by centrifugation. 

Table No 15. 

[Milk from a healthy cow (No. 2) was centrifuged for twenty minutes at 1,500 revolutions 
per minute. Part of the supernatant fluid was passed through a Berkefeld filter and a 
clear bluish serum obtained. Five sets of tubes were inoculated with 24-hour agar 
cultures, (1) the filtered clear serum, (2) the supernatant fluid free from leucocytes, 
(3) the sediment rich in leucocytes, (4) the original whole milk, and (5) sterilized milk. 
The inoculations were made three hours after milking.] 



Bacteria 
per loop, 
at once 
after inoc- 
ulation. 



Bacteria per loop after 
8 hours at 37° C 



Shaken 

moderately 

before 

planting. 



Vigorous 
agitation 

before 
planting. 



B. typhosus in filtered milk serum 

B. typhosus in leucocyte-free supernatant fluid 

B. typhosus in leucocyte-rich sediment 

B. typhosus in whole raw milk 

B. typhosus in sterilized milk (control) 

B. lactis aerogenes in filtered milk serum 

B. lactis aerogenes in leucocyte-free supernatant fluid 

B. lactis aerogenes in leucocyte-rich sediment 

B. lactis aerogenes in whole raw milk 

B. lactis aerogenes in sterilized milk (control) 

Original milk 



22, 000 
19, 000 
32, 000 
3,500 
16,000 

33,000 
4,000 

42, 000 
5,400 

36,000 

19 



10, 000 

1,900 

3,600 

1,200 

a b 160, 000 

a b 330, 000 

210 

740 

33 

o6 360,000 



15, 000 



92 



Innumerable. 



& About. 



This table also shows the effect of shaking the milk in breaking up 
bacterial clusters. 



475 

Table No. 16. 

[The milk was brought to the laboratory and inoculated with the cultures two hours after 
milking. The time given, however, is from the hour of inoculation. When obtained, 
the whole milk contained 1,200 bacteria per cubic centimeter. The sediment, rich in 
leucocytes, contained 630 bacteria per cubic centimeter, and the milk serum 490. The 
milk was revolved in a centrifuge at 1,500 revolutions for twenty minutes ; the sediment 
pipetted off was rich in leucocytes. The supernatant serum was drawn off and filtered 
three times through asbestos and was therefore free of leucocytes. The milk was 
inoculated with a pure culture of B. lactis aerogenes and B. typhosus. Four test tubes 
were prepared with each culture, (1) whole milk, (2) the sediment rich in leucoytes, 
(3) the milk serum containing no leucocytes, and (4) sterilized whole milk used as a 
control.] 



Bacteria 
per loop, 
at once 
after in- 
ocula- 
tion. 



Bacteria per loop after — 



3 hours 
at37°C. 



6 hours 
at37°C. 



9 hours 
at37°C. 



B. lactis aerogenes: 

Whole milk 

Sediment, rich in leucocytes. 
Milk serum, no leucocytes. . . 

Control, sterilized milk 

B. typhosus: 

Whole milk 

Sediment, rich in leucocytes 
Milk serum, no leucocytes. . . 
Control, sterilized milk 



1,500 
1,200 
1,400 
1,300 

7,200 
6,100 
4,200 
3,700 



30 

31 

52 

25,000 

5,000 
2,400 
2,800 
15, 000 



2 

6 

8 

200, 000 

1,500 

2,300 

3,900 

67, 000 



46 
34 
370 
(«) 

1,700 

1,600 

14, 000 

(a) 



a Innumerable. 



The milk in both of these experiments was obtained from a healthy 
cow (No. 2) in a cleanly manner, but without special precautions. 

The tables give the number of bacteria per loop on agar, grown at 
37° C. and counted after twenty-four hours. 

These tables eliminate the leucocytes and phagocytosis as a material 
factor in the problem we are studying. 



IS THE GERMICIDAL ACTION SPECIFIC? 

Almost all those who have studied this part of the problem con- 
clude that the germicidal action of milk is specific. The following 
experiment confirms these observations. Here we have the same 
milk showing an active power of restraining the growth of typhoid 
and staphylococcus pyogenes aureus, but not paratyphoid A or B. 

Reference to our work upon the influence of heat (vide infra) upon 
this property of milk also indicates its specific nature. 

The table again demonstrates that agglutination plays at least 
some part in the apparent decrease. 



476 

Table No. 17. — Milk from healthy cow (No. 2). 

[Inoculated one and one-half hours after milking. Controls, same milk heated to boiling. 
Organisms from 24-hour agar culture, using suspension in water of condensation in test 
tube.] 



Bacteria 
per loop at 
once after 

inocula- 
tion. 



Bacteria per loop after 
10 hours at 37° C. 



Test tube 
mod- 
erately- 
shaken. 



Vigorous 
agitation 
of culture 
for 5 min- 
utes. 



B. typhosus in raw milk 

B. typhosus in control 

B. para typhosus A in raw milk . 
B. para typhosus A in control . . . 

B. para typhosus B in raw milk . 
B. para typhosus B in control 

Staph, pyog. aureus in raw milk. 
Staph, pyog. aureus in control .. 

Original milk 



1,760 
2,100 

2,740 
2,300 

2,460 
3,200 

1,420 
1,830 



1,700 



12, 500 



(«) 
(«) 



900 
6,640 

42 



100 



a Innumerable. 
THE EFFECT OF DILUTION. 

Whole raw milk from a healthy cow (No. 2) was diluted in the 
proportion of 1 volume of milk to 3 volumes of distilled water. 
Inoculations were made two hours after milking; 24-hour agar cul- 
tures used. 

Table No. 18. 



Bacteria 
per loop at 
once after 

inocula- 
tion. 



Bacteria per loop after 
10 hours at 37° C 



Tube 
shaken 
moder- 
ately. 



Culture 
vigorously 
agitated 6 

minutes 

and mixed 

with a 

pipette. 



B. typhosus in diluted milk (1+3) 

B. typhosus in same milk undiluted 

B. typhosus in sterilized milk (control) 

B. lactis aerogenes in diluted milk (1+3) 

B. lactis aerogenes in same milk undiluted 

B. lactis aerogenes in sterilized milk (control) 

a Innumerable. 



11, 000 
35, 000 
16, 000 

3,000 

5,400 

36, 000 



3,000 

1,200 

a b 160, 000 

4,000 

33 

a b 360, 000 



25, 000 
15,000 



67, 000 
92 



b About. 



477 



Table No. 19. — Milk from a healthy cow (No. 2), inoculated one and one-half 

hours after milking. 



[Controls, same milk heated to 100° C. in Arnold sterilizer for ten minutes, 
from 24-hour agar cultures, suspended in normal salt solution.] 



Organisms 



Bacteria 
per loop at 
once after 

milking. 



Bacteria per 
loop after 7£ 
hours at 37° 

C. Tube 
shaken mod- 
erately. 



B. lactis aerogenes in raw milk diluted with same milk boiled (raw 3 parts, 

boiled 1 part) 

B. lactis aerogenes in same milk undiluted 

B. lactis aerogenes (control, i. e., boiled milk) 



B. typhosus in raw milk diluted with boiled milk as above (3+1) 

B. typhosus in same milk undiluted 

B. typhosus (control, i. e., boiled milk) 

Staphylococcus pyogenes aureus in raw milk diluted with boiled milk as 

above (3-f 1) 

Staphylococcus pyogenes aureus in same milk undiluted 

Staphylococcus pyogenes aureus (control, i. e., boiled milk) 

Original milk 




9,000 
30, 000 



(a) 



2,100 
2,340 



(«) 



1,530 
1,320 
50, 000 

430 



a Innumerable. 

Dilution has an appreciable effect. For instance, in Table No. 18 
there was a reduction of 96.6 per cent in the number of colonies of 
typhoid in whole milk, but only 73 per cent in the diluted milk. A 
similar effect is shown in relation to B. lactis aerogenes. 

These experiments were originally designed to demonstrate the 
presence of a germicidal substance in solution, but the results again 
show that the action is in part at least due to agglutination. As far 
as the restraining action is concerned, the results resemble a feeble 
antiseptic rather than a germicide. 

THE EFFECT OF HEATING AND FREEZING. 

The effect of heat varies with the micro-organism. The power to 
restrain B. lactis aerogenes is weakened and destroyed before that for 
typhoid. Thus, 55° C. for thirty minutes or 60° C. for twenty 
minutes markedly alters or destroys the power of milk to restrain the 
B. lactis aerogenes, while this degree of heat shows little influence as 
far as B. typhosus is concerned. 

Freezing milk for ten minutes apparently does not influence its 
germicidal power. Freezing the milk for forty-eight hours before 
inoculating it has no influence upon its restraining action as far as 
the typhoid organism is concerned, but apparently destroys this 
power for B. lactis aerogenes. 



478 

In the freezing experiments a small quantity of the milk was 
frozen solid by a mixture of salt and ice and kept in this condition 
for the periods stated. It was then cautionsly thawed and inoculated 
with the micro-organisms to be tested. 

The reason for selecting the temperatures used in Table No. 20, viz, 
55° C. and 65° C, was to differentiate the true bactericidal from the 
agglutinating substances, based upon similar work upon blood serum. 

Table No. 20. — Milk from a healthy cow (No. 2) inoculated two hours after 

milking. 



Bacteria 
per loop at 
once after 

inocula- 
tions. 



Bacteria 

per loop 

after 8 

hours 

at 37° C. 



B. typhosus in milk first frozen 10 minutes 

B. typhosus in milk heated to 60° C. 20 minutes 

B. typhosus in milk heated to 80° C. 20 minutes 

B. typhosus in the whole raw milk 

B. typhosus in sterilized milk (control) 

B. lactis aerogenes in milk first frozen 10 minutes , 

B. lactis aerogenes in milk heated to 60° C. 20 minutes 
B. lactis aerogenes in milk heated to 80° C. 20 minutes 

B. lactis aerogenes in the whole raw milk 

B. lactis aerogenes in sterilized milk (control) 

Original milk 



(a) 

8,000 
18, 000 

3,500 
16, 000 

10, 000 
11,000 
20,000 
5,400 
36,000 

19 



12,000 

a b 380, 000 

1,200 

a b 160, 000 

1,700 

a b 50, 000 

a b 400, 000 

33 

ob 500, 000 

42 



a Innumerable. 



>About. 



Table No. 21. — Milk from healthy cow (No. 2) inoculated two hours after 

milking. 

[24-hour culture used in each case.] 



Colonies 
per loop 
at once 
after 
inocu- 
lation. 



Colonies per loop after 
10 hours at 37° C 



Shaken. 



Vigorously 
agitated. 



B. typhosus in raw milk untreated 

B. typhosus in milk heated to 55° C 30 minutes 

B. typhosus in milk heated to 65° C 30 minutes 

B. typhosus in milk boiled 1 minute 

B. lactis aerogenes in raw milk untreated 

B. lactis aerogenes in milk heated to 55° C 30 minutes 
B. lactis aerogenes in milk heated to 65° C. 30 minutes 
B. lactis aerogenes in milk boiled 1 minute 

Original milk 



1,070 

1,350 

960 

1,150 

820 

1,500 

400 

950 



1,960 
2,400 
13, 000 

(a) 

12, 000 

(a) 
(a) 
( a ) 

18 



4,300 

17, 820 



15, 000 



a Innumerable. 



& About. 



479 

Table No. 22. — Milk from healthy cow (No. 2) inoculated three hours after 

milking. 
[24-hour agar culture used in each case.] 



Bacteria 
per loop 
at once 
after 
inocu- 
lation. 



Bacteria per loop after 
9 hours at 37° C. 



Shaken. 



Vigorously- 
agitated. 



B. typhosus in whole raw milk 

B. typhosus in whole milk heated to 60° C. 20 minutes 
B. typhosus in sterilized milk (control) 

B. lactis aerogenes in whole raw milk 

B. lactis aerogenes in milk heated to 60° C. 20 minutes 
B. lactis aerogenes in sterilized milk (control) 

Original milk 



6,500 

10,000 

9,000 

5,300 
7,000 
7,500 



2,300 

3,400 

ob 200, 000 

325 

11,000 

«b 150, 000 

73 



14, 000 



1,700 



° Innumerable. 



About. 



Table No. 23. — Milk from healthy cow (No. 2) inoculated one and one-half 

hours after milking. 

[24-hour agar culture in each case.] 



Bacteria 
per loop at 
once after 

inocula- 
tion. 



Colonies per loop after 
10 hours at 37° C. 



Shaken. 



Vigorously 
agitated. 



B. typhosus in whole raw milk 

B. typhosus in whole milk heated to 60° C. 30 minutes 

B. typhosus in whole milk heated to 70° C. 30 minutes 

B. typhosus in whole milk first frozen for 48 hours 

B. typhosus in milk boiled for 1 minute (control) 

B. lactis aerogenes in whole raw milk 

B. lactis aerogenes in whole milk heated to 60° C. 30 minutes 

B. lactis aerogenes in whole milk heated to 70° C. 30 minutes 

B. lactis aerogenes in whole milk first frozen 48 hours 

B. lactis aerogenes in whole milk boiled for 1 minute (control) . . 

Original milk 



1,000 
1,700 
2,100 
1,520 
1,800 

2,000 
1,670 
870 
1,040 
3,000 

13 



3,500 

18,000 

a b 200, 000 

1,020 
a b 400, 000 

29,000 

«X100 
ox 100 
«X 20 
«X 30 

210 



19, 500 

43,000 

a b 300, 000 



75,000 
ox 100 
ox200 



a Innumerable. 



About. 



X Means about the stated number of times the number of colonies shown in the first 
column. 



REVIEW OF THE LITERATURE UPON THE SUBJECT. 

It will be seen from the following review of the literature upon 
this subject that our work confirms the facts which have been re- 
corded by some others. There is, however, a disagreement concerning 
the interpretation of these facts. One class of observers, while admit- 
ting that there is a primary reduction of bacteria in fresh raw milk, 
believes this to be entirely independent of any germicidal action of 
that fluid. The reduction is attributed to other causes, such as a 



480 

" restraining " action of the milk, inhibition resulting from strange 
media, etc. Others believe that fresh raw milk possesses definite, 
though feeble, germicidal properties. Some of the authorities cited 
absolutely deny not only the germicidal but also the restraining 
power of milk, claiming a steady increase in numbers from the start. 

Fokker was the first to call attention to the bactericidal prop- 
erties of milk. He was led to investigate this subject through the 
results of Nuttall, Buchner, and Lubarsch, who found that blood 
contained substances capable of destroying bacteria. Fokker 
obtained goats' milk under careful aseptic precautions and divided 
it into two portions, one of which was heated, and both portions 
then infected with bacteria of souring milk. The cooked portion 
would always sour within twenty-four hours, while the fresh, un- 
heated portion would keep at least, and sometimes more than, three 
or four days. 

He also noted that by the use of cultures on plates there was first 
a diminution in the number of bacteria in milk. He further found 
that the brief heating of milk did not always destroy its bactericidal 
properties, but that prolonged heating at 70° C. is sufficient to destroy 
this action. 

Uffelmann 6 observed the multiplication of cholera vibrios during 
the first twelve to sixteen hours in raw milk to be less than in the 
controls with cooked milk. 

Weigmann and Zirn G also investigated the question of cholera 
vibrios in raw milk and found a diminution in the first four hours, 
but not in cooked milk. They believe that the presence of acid 
causes the killing of the vibrios. 

A few years later, 1894, Hesse d confirmed the pioneer work of 
Fokker and stated most positively that cholera and typhoid are 
both killed by fresh milk and concludes from his studies as follows : 

The killing of the organisms begins the moment the cholera bacilli are added 
to the milk. This is complete, almost without exception, at room temperature 
(15°-20° C.) within twelve hours; at incubator temperature within six to eight 
hours. The destruction of the organisms is independent of the acid content of 
the milk, and independent of the milk organisms and their metabolic products. 
It is more probably to be looked upon as a vital function of the living milk, 
which is immediately lost upon heating to 100° C. 

He, therefore, recommended the use of raw milk as a therapeutic 
measure in cholera. 

a Fokker, A. P. : Ueber die bacterienvernichtenden Eigenschaften der Milch. 
Fortschr. der Med., vol. 8, 1890, p. 7. 

& Uffelmann, J. : Beitrage zur Biologie des Cholerabacillus. Berl. klin. Woch., 
vol. 29, 1892, p. 1209. 

c Weigmann, H., and Zirn, Gg. : Ueber das Verhalten der Cholerabakterien in 
•Milch und Molkereiprodukten. 

d Hesse, Walter : Ueber die Beziehungen zwischen Kuhmilch und Oholerabacil- 
len. Zeit. f. Hyg., vol. 17, 1894, p. 238. 



481 

Basenau, a 1895, disagrees with Hesse in that he could not confirm 
the destruction of cholera vibrios in raw milk, but found, on the con- 
trary, that these organisms multiply vigorously from the start. He 
also experimented with B. morhificans bovis (enteritidis group) with 
the same result. He drew his milk from a healthy cow under spe- 
cial antiseptic precautions, but could not demonstrate definite bacte- 
ricidal substances in the milk. At most Basenau believes that there 
is only a temporary restraining power, and he found that a similar 
restraining action was present when bacteria were transplanted into 
nutrient bouillon, and therefore this property is not specific for milk. 

Heim & agrees with this view and adds to the list of organisms 
which are not affected typhoid and tubercle bacilli. 

Schottelius, c Kitasato d and Friedrich e confirm the work of Base- 
nau and Heim upon the lack of bactericidal properties of fresh milk. 

Cozzolino f studied asses', cows', goats', and human milk, finding 
a reduction of organisms in a portion of the experiments, asses' milk 
being the strongest and goats' milk the weakest in bactericidal activ- 
ity. Human milk is unique in its behavior toward B. coli communis, 
reducing the numbers materially during the first fourteen to twenty- 
four hours. Cozzolino, however, used milk which he endeavored to 
render sterile by heating to 55° to 58° C. for one hour on each of eight 
successive days. 

Schenk 5 ' found a bactericidal substance in human milk, though in 
small quantities. 

Hunziker/ 1 1901, showed that the action of the germicidal sub- 
stance or condition varied with the individual cow and that its dura- 
tion was influenced by the degree of temperature at which the milk 
was kept. The germicidal action was most rapid at comparatively 
high temperatures and the minimum number of bacteria was reached 
in a comparatively short time, while at the lower temperatures the 
intensity of the action was lessened and its duration was increased 
so that the minimum number was reached at a later period. 

Klimmer,* as a result of his work, concludes that human milk 
lowers the number of organisms greatly, but that asses' milk develops 

a Basenau, Fritz : Ueber die Ausscheidnng von Bacterien durch die thatige 
Milch druse und iiber die sogen. bactericiden Eigenschaften der Milch. Arch. f. 
Hyg., vol. 23, 1894, p. 44. 

6 Heim: Arb. Kais. Gesundhamte., vol. 4, p. 294. 

c Schottelius : Centralbt. f . Bakteriol., v. 20, no. 25, Dec, 1896, p. 897. 

d Kitasato, S. : Das Verhalten der Cholerabacterien in der Milch. Zeit. f. 
Hyg., vol. 5, 1889, p. 491. 

e Friedrich : Arb. a. d. Kais. Gesndhtsamte., vol. 13, p. 465. 

f Cozzolino : Arch. f. Kinderheilkunde, vol. 33, p. 405. 

9 Schenk : Monattsschr. f. Geb. u. Gyn., vol. 19, 1904. 

n Hunziker : Cornell Univ. Agr. Exper. Sta., Bull. 197, 1901. 

* Klimmer : Arch. f. Kinderheilkunde, vol. 36, 1903, p. 1. 
45276°— Bull. 56—12 31 



482 

a specific bactericidal activity. He does not look upon the reduced 
number of bacteria as a result of the bactericidal activity, but believes 
it to be due rather to a change in the media. 

Moro a denies all bactericidal properties of raw milk so far as the 
cholera, typhoid, and colon bacteria are concerned. This he found 
true of cow's as well as of woman's milk. He found, however, that 
the serum of breast-fed children had greater bactericidal properties 
than the serum of children raised on cooked milk. 

Park & studied this question in 1901 and concluded that freshly 
drawn milk contains a slight and variable amount of chemical sub- 
stances which are capable of inhibiting bacterial growth. At 
temperatures under 50° F. these substances act efficiently, unless the 
milk is filthy, for from twelve to twenty-four hours, but at higher 
temperatures their effect is very soon completely exhausted, and the 
bacteria in such milk will then rapidly increase. Thus the bacteria 
in fresh milk which originally numbered 5,000 per cubic centimeter 
decreased to 2,400 in the portion kept at 42° F. for twenty-four hours, 
but rose to 7,000 in that kept at 50° F., to 280,000 in that kept at 
65° F., and to 12,500,000,000 in the portion kept at 95° F. 

Park, c 1901, believes this property is too elusive to be of practical 
use in dairying. 

Conn,^ 1903, confirmed the fact that during the first six hours 
there is a dimunition in the number of bacteria in raw milk, but 
leaves the question open whether we are dealing with germicidal 
properties in raw milk or whether the organisms are simply becom- 
ing more accustomed to their new medium. 

Heinemann e reported some investigations upon the subject 
which may reconcile the results of the different writers. He finds 
that for certain species of bacteria there is a bactericidal substance 
in raw milk while for other species there is none. Moreover, this 
germicidal property does not assert itself after the milk is from five 
to seven hours old. This power is also destro}^ed after heating milk 
to 56° C. for thirty minutes or by bringing it to the boiling point. 

Stocking/ 1904, investigated this question by studying the multi- 
plication of certain groups of bacteria, and concluded that many of 

a Moro : Munch, med. Woch., vol. 48, Oct., 1901, p. 1770 ; also Arch. f. Kinder- 
heilkunde, vol. 33, p. 435, 1902. 

1 Park, William H. : The great bacterial contamination of the milk of cities, 
can it be lessened by the action of health authorities? N. Y. Univ. Bull, of Med. 
Sci., vol. 1, 1901, p. 71. 

c Park, William H. : N. Y. Univ. Bull. Med. Sci., vol. 1, 1901. 

d Conn, W. H. : Bacteria in milk and its products. London, 1903, p. 98. 

e Heinemann, Paul Gustav : The kinds of bacteria concerned in the souring of 
milk. Chicago, 1903. 

f Stocking, W. A., Jr. : The so-called " germicidal property " of milk. Storrs 
Agric. Sta. Bull. 28, 1904, p. 89. 



483 

the species gaining access to the milk find the condition so different 
to their natural habitat that they are not able to multiply and there- 
fore they drop out very soon. On the other hand, common lactic- 
acid organisms multiply more or less rapidly and continuously from 
the start. He believes that the reduction in the number of bacteria 
during the first few hours is not the result of any germicidal condi- 
tion or property possessed by the milk, but simply the natural drop- 
ping out of those species which do not find the milk a suitable 
medium in which to develop. 

Behring, a 1904, in his recent publications claims that milk has 
similar bactericidal property to that possessed by the blood. Fur- 
ther, that these bactericidal substances are rendered inactive at 60° 
C. for one hour or 50° C. in vacuo. He believes that heating milk to 
60° C. for sixty minutes appreciably weakens the immune bodies 
contained in it, and that the great mortality of infants in large 
cities has a direct relation to the use of cooked milk. He believes 
that the important point in infant feeding is to use milk in which 
the native antibodies are intact. He uses this as one of his argu- 
ments in advocating the use of formaldehyde to preserve milk. 

Friedel, Kutscher, and Meinicke, 6 1904, working under Kolle's 
direction, in Koch's Institute for Infectious Diseases, at Berlin, found 
as a result of numerous experiments that fresh raw milk contains 
bactericidal properties, similar to those of fresh blood serum, against 
the cholera vibrio. But no such property was found as far as the 
typhoid, paratyphoid, and dysentery bacilli, the organism of meat- 
poisoning, and B. coli are concerned. 

They found that fresh raw milk has a feeble property of restrain- 
ing the growth of the dysentery bacillus. This property is not de- 
stroyed by heating the milk to 60° C. for one hour, but is destroyed 
above 70° C. These investigators believed that this property of milk 
in question is a restraining action and not a bactericidal one, espe- 
cially in view of their dilution experiments. 

They found that the bactericidal property of milk, as far as the 
cholera organism is concerned, is weakened by heating the milk to 
60° C. and by the addition of hydrochloric acid, pepsin, and sputum. 

Knox and Schorer find that neither raw nor pasteurized milk 
seems to exert any definite deterrent action upon the growth of the 

a Behring, E. : Sauglingsmilch und Sauglingsterblichkeit. Therapie die Gegen- 
wart, n. s., vol. 4, 1904, p. 1-10. 

6 Untersuchungen fiber die bakteriziden und entwickelungschemmenden Wirk- 
ungen der rohen und der auf verschiedene Temperaturen erwarmten Milch 
gegen iiber den oben gennanten Bakterien. Klinische Jahrbuch, vol. 13, 1904-5, 
p. 328. 

c Knox, J. H. Mason, and Schorer, Edwin H. : A study of hospital and dispen- 
sary milk in warm weather, with special reference to pasteurization. Arch, of 
Pediatrics, July, 1907. 



484 

dysentery bacillus, and conclude that it is evident that the much 
talked of bactericidal action of milk is of little or no aid in maintain- 
ing the low count desired in a milk used in infant feeding. 

[Since publishing our article the following additional references 
to the literature have come to our notice:] 

Coplans a points out that two phenomena must be considered when 
organisms are transferred to a new medium. First, a period of 
latency due to change of environment (nature of food supply, reac- 
tion, and temperature). During this period of latency there is little 
or no increase in number. The second phenomenon is one observed 
in the case of fresh raw milk. It is a bactericidal inhibitory property. 

He showed that during the first six hours there is a reduction in the 
number of B. coli in raw milk, but no change in the number in boiled 
milk. At the end of twenty-four hours the increase in numbers in 
boiled milk is twenty times as great as in raw milk; at the end of 
forty-eight hours there is little difference in the numbers in raw and 
boiled milk. He holds that a given quantity of fluid can harbor only 
a certain number of organisms; therefore the number of bacteria 
planted has something to do with the rapidity of growth. 

An interesting point demonstrated by Coplans is the fact that the 
addition of enough boric acid to merely check the growth of organ- 
isms in milk abolishes all bactericidal property of the fluid. 

Moro, 6 in a recent investigation, found that unfiltered raw cow's 
milk always effected a diminution in the number of colonies of B. 
typhosus during the first few hours. He believes this action is due to 
a true bacteriolytic alexin. Human milk never brought about any 
actual reduction in the number of B. typhosus, but restrained the mul- 
tiplication as compared with the boiled milk. He found that passing 
cow's milk through a Berkefeld filter deprived it of the power to 
reduce the number of bacteria or to restrain their multiplication. 

St. John and Pennington c found that the heating of milk to 79° C. 
not only took away the power to bring about an initial decrease in 
the number of organisms, but destroyed the power to restrain the 
multiplication of bacteria throughout the period of observation, 
which was to the souring point. They call attention to the great 
care necessary in handling milk after commercial pasteurization, as 
when infected the growth of organisms is much greater than in milk 
not subjected to the process. The raw milk usually remained sweet 
twenty-four hours longer than pasteurized milk reinfected with 
organisms from the raw milk. They considered organisms only 
that were normally present in milk. 

° Coplans, Lancet, pp. 1074-1080. October 19, 1907. 
6 Moro, Zeit. f. exp. Path. u. Therap., pp. 470^79. Berlin, 1907. 
c St. John and Pennington, Journal of Infectious Diseases, vol 4, No. 4, pp. 
647-656. 1907. 



485 

Evans and Cope a have recently experimented upon the bactericidal 
property of milk and have reached the following conclusions: 

1. Freshly drawn milk possesses a bactericidal activity toward cer- 
tain micro-organisms and an inhibitory activity toward others. 

2. This activity is destroyed at 68° C. and materially injured at 
55° C. It varies in different cows and lasts from six to twelve hours. 

3. Coagulation and acidity of milk do not depend solely upon the 
bacterial content. They are influenced by natural properties of milk, 
which are soon overshadowed by the metabolic products of bacteria. 

4. Sterile cow's milk freshly drawn is acid to phenolphthalein and 
increases very slowly in acidity independent of bacterial metabolism, 
due probably to the destruction of colostrum cells. 

5. Results obtained in testing milk with mixed bacterial florae are 
influenced by bacterial antagonism. 

Rullmann and Trommsdorff h state that they made a number of 
tests concerning the bactericidal properties of fresh milk. They state 
however, that unfortunately their experiments have not yet given 
them as clear a picture as they would wish of this apparently rather 
complicated phenomenon. However, they state that it seems justi- 
fiable to draw certain conclusions from their work without giving 
any of the details of the experiments. The conclusions follow: 

(1) That the bactericidal power of milk is increased when it comes 
from udders the seat of mastitis (increased secretion of serum and 
also of alexin? influence of bacteria upon the (local?) production of 
immune bodies in the milk ? ) . 

(2) That there is a direct relation between the bactericidal prop- 
erty of milk and the number of leucocytes that it contains. 

In a recent study upon the germicidal action of cow's milk Heine- 
mann and Glenn c conclude as follows : 

The decrease of bacteria in fresh cow's milk is more decided if 
fairly large numbers are inoculated than if small number only are 
present. 

The relative increase of bacteria in milk is more pronounced in 
milk heated to 75° C. or 100° C. than in raw milk or milk heated to 
56° C. 

The difference in the relative decrease in numbers of bacteria in 
milk moderately shaken and vigorously shaken is not marked if this 
shaking is done by hand. Some difference was observed, however, 

° The bactericidal property of milk, by Joseph. S. Evans and Thomas A. Cope, 
University of Pennsylvania Medical Bulletin, Vol. XXI, pp. 264-274. 1908. 

6 Milchhygienische Untersuchungen, W. Rullmann and R. Trommsdorff, Archiv 
fur Hygiene, Vol. LIX, pp. 224-265. 1906-7. 

c Heinemann, P. G., and Glenn, T. H. : " Experiments on the germicidal action 
of cow's milk," Journ. Infec. Dis., Vol. V, pp. 534-541, Dec. 18, 1908. 



486 

and this difference might be more pronounced if the milk were shaken 
more violently. 

Some species occurring naturally in milk decrease considerably in 
numbers during the first four or five hours, some decrease slightly, 
some hold their own or even increase. 

Milk inoculated with pure cultures of bacteria seems to restrain to 
a marked degree the multiplication of these bacteria for several hours 
at 37° C. and for a somewhat longer period at room temperature, ex- 
cepting in the case of Strept. lacticus, which increases from the begin- 
ning, although it may be inhibited to some extent. 

Heating milk to 56° C. for thirty minutes does not entirely destroy 
the power to restrain the multiplication of bacteria; this power is 
weakened, however, and at 75° C. is destroyed entirely. This fact, 
together with the fact that milk serum agglutinates some species of 
bacteria in vitro to a marked degree, seems to favor the assumption 
that agglutinins are in part responsible for the apparent decrease of 
bacteria in fresh milk, since bactericidal substances are destroyed by 
heating to 56° C. for thirty minutes. 

The agglutination of certain bacteria in milk serum seems to bear 
some relation to the apparent decrease in numbers of bacteria ob- 
served in fresh milk, but this is probably not the only factor causing 
such reduction. 

SUMMARY AND CONCLUSIONS. 

Judged by the number of colonies that develop upon agar plates, 
the bacteria in milk first diminish then increase in number. This so- 
called germicidal property of milk occurs only in the fresh raw fluid. 

For the most part, our work plainly shows that no actual reduction 
in the number of bacteria occurs. However, when compared with 
the controls a restraining action is evident. The phenomenon there- 
fore appears to resemble that of a weak antiseptic rather than that of 
a true germicide. 

When milk is kept warm (37° C), the decrease is pronounced 
within the first eight or ten hours. After this time the milk has 
entirely lost its restraining action. 

When the milk is kept cool (15° C), the decrease is less marked, 
but more prolonged. 

The decrease in the number of bacteria is largely apparent, being 
due at least in part to agglutination. 

The bacterial clusters may, to a certain extent, be shaken asunder. 
This fact goes far to reconcile the discordant results of the various 
investigations upon the germicidal properties of milk. Those who 
used dilution methods with vigorous agitation broke up the bacterial 
clusters, and thus obtained a larger number of colonies upon agar 
plates than those who plated directly with different technique. 



487 

Some of the leucocytes in milk seem to possess the power of phago- 
cytosis, judged by microscopic preparations. Phagocytosis, however, 
plays no essential part in the " germicidal " action of milk, for the 
decrease in numbers is quite as marked in the cell- free milk as in the 
sediment rich in leucocytes. 

The germicidal action of milk is specific. For instance, one sam- 
ple restrained typhoid and Staphylococcus pyogenes aureus, but not 
paratyphoid A or B. 

Dilution experiments demonstrate the enfeeblement of agglutinins 
rather than the presence of a germicidal substance in solution. 

The germicidal actions of blood and milk resemble each other in 
some particulars. Blood serum acts more quickly and much more 
powerfully than milk. 

Freezing milk for ten minutes and then thawing it does not affect 
the phenomenon in question. In one experiment freezing for forty- 
eight hours did not influence its restraining action upon typhoid, but 
destroyed it for B. lactis cerogenes. 

Boiling milk or heating it above 80° C. destroys its " germicidal " 
properties. The effect of lesser degrees of heat varies with the micro- 
organism. Thus, the restraining action for B. lactis cerogenes is 
weakened by first heating the milk at 55° C. and almost destroyed at 
60° C. ; for typhoid it is not affected by heating the milk at 60° C. 
for twenty minutes, but is materially influenced at 70° C. for thirty 
minutes. 

The " germicidal " action of milk varies in different animals and in 
the milk from the same animal at different times. At most, the action 
is variable and feeble. It can not take the place of cleanliness and 
ice, but may be taken advantage of in good dairy methods. 



13. THE SIGNIFICANCE OF LEUCOCYTES AND 
STREPTOCOCCI IN MILK. 



(489) 



THE SIGNIFICANCE OF LEUCOCYTES AND STREPTOCOCCI 

IN MILK. 



By William Whitfield Miller « 
Assistant Surgeon, Public Health and Marine-Hospital Service. 



In the search for better and simpler methods for detecting milk 
from diseased cows, especially when mixed with the milk from healthy 
cows, as may be the case in market milk, particular attention has 
been paid to the presence of leucocytes and streptococci. In America, 
and to some extent abroad, much work has been done by State and 
city health authorities in the examination of dairy milk, with a view 
to determining the significance of these elements, and fixing standards 
limiting their number in acceptable dairy milk. It was early observed 
that in the milk of cows with udder disease of an inflammatory nature, 
pus cells and streptococci were almost invariably present in large 
numbers. Following this observation, examinations were made to 
determine how often leucocytes and streptococci were present in 
market milk. The result showed that they were present in the 
majority of milks to a greater or less extent. They were not so 
numerous, however, as in the milk of diseased animals. The interpre- 
tation placed upon these findings — viz, that one or more of the cows 
of the dairy herd from which the milk was derived was affected with 
garget (an inflammation of the udder) — is no longer regarded as 
strictly correct, since it is now well proven that the normal milk of 
healthy cows always contains leucocytes and usually streptococci. 
In the last two or three years work has been done that throws a new 
light on the subject and explains some of the discordant results pre- 
viously obtained. 

Whether the polymorpho-nuclear cells found in all milk shall be 
regarded as leucocytes or pus cells has been a subject of much dispute. 
As they were first looked upon as pus cells, it is readily understood 
why repugnance was felt at the idea of taking them in food, even if 
they were harmless. The earlier observers detected these cells in a 
large number of specimens of milk, but not in all, and concluded that 
they indicated some degree of inflammation of the udder. They 
fixed an arbitrary number (to a certain quantity of milk) as a limit, 

a This article is reprinted without revision, owing to Doctor Miller's death, Novem- 
ber 24, 1908. 

(491) 



492 

beyond which the milk was regarded as unfit for use. In other 
words, it was only a question to what extent the evil was to be 
endured. The present views concerning cellular elements in cows' 
milk are somewhat different. 

Histologists long ago pointed out that leucocytes occur in milk, 
when the gland structure showed no evidence of inflammation. Co- 
lostrum corpuscles are regarded as leucocytes loaded with debris of 
gland cells removed to clear up the channels for milk flow. It seems 
but natural that such a remarkable and rapid metabolic process as 
milk formation should be accompanied by a large number of leuco- 
cytes. In fact, in sections of normal functionating mammary glands 
they are found to be numerous in the capillaries and in the connective 
tissue spaces between the alveoli, from which they make their way 
between the gland cells and appear in the milk. 

As regards leucocytes and pus cells there is no intrinsic difference. 
A leucocyte in fluids other than blood plasma — as milk, for example — 
soon undergoes changes which render it indistinguishable from a pus 
cell. That pus does occur hi milk from inflamed mammary glands 
need scarcely be mentioned. Before considering further the signifi- 
cance of leucocytes, it will be of interest to note the various methods 
used for counting them. Stokes and Wegefarth a were the first to 
attempt an enumeration. Briefly, their method consisted in cen- 
trifuging a definite quantity of milk, spreading the entire sediment 
on a slide over a definite area, staining and examining with a T V-hich 
lens ; the number of leucocytes in ten or more fields of the microscope 
was noted, and an average struck. From this data an estimate was 
made of the number per cubic centimeter. 

Stewart b and Slack c used a refinement of the same method. 
Doane-Buckley d modified the procedure in common use for counting 
blood cells, employing the Thoma-Zeiss instrument, with quite accu- 
rate results. 

Savage 6 used a very similar method. Still another way of estimat- 
ing the leucocytes is based on a procedure applied to blood — the use of 
a modified hematocrit, in which the milk is centrifuged and the leuco- 
cytes read on a scale, as sediment in volume per cent. Trommsdorff, f 
in Germany, has perfected this method. As might be expected differ- 
ent methods give widely different results. Bergey in a recent paper 
records a number of comparative counts by the Stokes, Stewart, 

a Medical News, 1897, No. 91, p. 45. 

b American Medicine, 1905, No. 9, p. 486. 

c Journ. of Infect. Diseases, 1906, Sup. No. 2. 

d Maryland Agric. Exper. Station, 1905, Bull. 102. 

«Brit. Med. Jour., 1905, No. 1, p. 1165. . 

/Munch. Med. Woch., 1906, No. 53, S. 541. 

?Univ. of Pa. Med. Bull., 1907, vol. 20, Sept. 



493 

Doane-Buckley, and Trommsdorf methods, which show great dis- 
crepancies. When making a number of counts from the same speci- 
men of milk the Doane-Buckley technique gave the least variation 
and as compared with the others the highest counts. Russell and 
Hoffmann in a similar comparison found the average variation 6 per 
cent using the volumetric, and 112 per cent using the smeared sedi- 
ment technique. Most recent writers agree that the latter method 
should be abandoned as too inaccurate to be of service. 

Concerning the number of leucocytes which have been found in the 
milk of healthy cows kept under the best conditions and counted by 
the most accurate methods, a great variation has been noted. Sav- 
age found numbers ranging from 35,000 to 4,500,000 per cubic centi- 
meter, and more than three-fourths of the cows gave milk that aver- 
aged more than 100,000 per cubic centimeter. About the same fig- 
ures were found for mixed milk from entire herds; more than four- 
fifths of the herds gave averages above 100,000 per cubic centimeter. 

Doane found the number of leucocytes in the milk of a large number 
of cows to average more than 200,000 per cubic centimeter. 

Russell and Hoffmann made a large number of counts from the milk 
of cows in which there was not the slightest clinical evidence of udder 
disease, nor had there been any history of such, and obtained results 
as high as 1,800,000, while 33 per cent gave counts higher than 
500,000 per cubic centimeter; 83 per cent of those with slight udder 
disease or a history of garget gave counts of 500,000 per cubic centi- 
meter or over. 

Tests of milk from the same cow, taken from day to day, show 
great variations, although in general it may be said that a milk show- 
ing a high count one day will show a high count the next day, but not 
necessarily the next week or month; this, of course, when the health 
of the animal continues unchanged. The period of lactation seems to 
have no constant influence, except that the colostrum corpuscles are 
greatly increased after parturition. Bergey has shown that widely 
different counts are often found in the milk from different quadrants 
of the udder. Buchholtz, 6 Czerney, c and Michaelis d have pointed 
out certain facts relating to the secretion of milk that explain some of 
these discrepancies. They found that retention of milk in the gland 
ducts and alveoli for an unusual period causes a large increase in the 
number of leucocytes in the milk. When the milk is allowed to accu- 
mulate in the udder instead of being removed at regular and proper 

« Journal of Infectious Diseases, 1907, Supplement No. 3, p. 63. 

&Inaug. Diss., Gottingen, 1877. 

cPrag. med. Woch., 1890, Bd. 15, S. 401-416. 

<*Arch. f. microsk. Anat., Bd. 51., S. 711. 



494 

intervals, favorable conditions for the migration of leucocytes are 
found. 

It was deemed advisable by the early students of the subj ect, who con- 
sidered all leucocytes in milk as " pus cells" and evidence of inflamma- 
tion of the udder, to fix a limit to the number which might be allowed 
in a market milk. Stokes (loc. cit.) regarded an average of 5 cells to 
the field of the microscope, using his counting method, as indicative of 
pus. Bergey a adopted 10 cells per field as a standard. Stewart 
(loc. cit.) regarded 23 cells per field and Slack (loc. cit.) 50 cells as a 
proper standard, all using a modification of Stewart's technique. 
Doane advocates 500,000 leucocytes per cubic centimeter, Tromms- 
dorff 10 volumes of sediment to 10,000 volumes of milk as a safe 
limit. Stewart's is the standard commonly employed in municipal 
health laboratories and corresponds roughly to 100,000 leucocytes per 
cubic centimeter. All of the above standards are arbitrary and are 
founded solely upon individual experience. The standard suggested by 
Trommsdorff limiting the amount of sediment in a centrifuged sample 
of milk seems valuable, not so much as an enumeration of the leuco- 
cytes as an indication of objectionable solid matter in suspension. It 
is of interest to note that although the number of leucocytes in milk 
from cows with diseased udders is usually much increased, Russell 
and Hoffmann have shown that this is not necessarily true, in some 
instances the count running below the average for normal milk. The 
daily variation in such cases often brings the count well within the 
usual normal limits. It seems likely that a numerical standard for 
leucocytes sufficiently high to include the milk of the greater majority 
of healthly cows would not be low enough to exclude in some cases the 
milk of cows with disease of the udder. Other and more definite signs 
of inflammation than that furnished by the leucocyte count alone 
must be sought. 

Doane (loc. cit.) states that the occurrence of fibrin is positive proof 
of the existence of inflammation and has devised ways of demon- 
strating its presence in milk. The matter requires further study. 
The leucocytes per se can not be regarded as deleterious or foreign 
ingredients of milk; it is scarcely reasonable to expect that a 
food so distinctly animal in its origin should contain no organized 
elements. 

The significance of pus in milk has been studied principally in 
connection with micro-organisms, looked upon as the exciting cause 
of the mastitis, with which the pus is associated. In the stained 
smears of milk sediment examined by the earlier investigators of 
leucocytes in cow's milk, attention was drawn to the large number 
of chain-forming micro-organisms (streptococci) present. They were 

a Bull. No. 125, Penna. Dept. Agric, 1904. 



495 

especially numerous in milk that clearly contained pus or was known 
to be derived from cows with mastitis. At that time all streptococci 
were believed to be pathogenic, and it was assumed that when such 
organisms were found in milk they pointed to disease of the udder 
and were capable of propagating disease when ingested with the milk. 
Recent investigators have so clearly demonstrated the close relation- 
ship existing between the micro-organisms, which cause spontaneous 
souring of milk, and the streptococci that it will be of interest to 
consider the former at some length. 

Pasteur, a Lister, b Hueppe, c and many others studied the souring 
of milk. Pasteur proved that micro-organisms were the cause, and 
Lister, twenty years later, isolated in pure culture a bacterium which 
he deemed the common agent. Subsequent bacteriologists have 
studied and described at length a great variety of bacteria found in 
ordinary dairy milk, capable of causing fermentation, with lactic acid 
formation. Many of these micro-organisms were later shown to 
have been introduced by unclean containing vessels and careless 
handling of the milk, and while capable of causing souring must be 
regarded as accidental and inconstant in occurrence. When drawn 
directly in sterile vessels with ordinary caution as regards cleanli- 
ness the variety of organisms is reduced to three or four. The 
technique of the early bacteriologist was somewhat imperfect, and 
cultural methods less exact than now. It is not surprising that 
identical bacteria were described by different observers as showing 
slight variations. 

A review of the work done since Hueppe d in 1884 (who was the 
first to apply modern methods to the study of milk bacteria) shows 
that the common lactic bacteria may be classified in three groups. 
The first includes the bacilli of the type first described by Esche- 
richia the Bacterium serogenes group. These organisms are classified 
with the colon group and owe their presence in milk to contamina- 
tion with the feces of the cow. 

Marpmann/ Grotenfeld,^ Loffler,^ Weigemann/ Kayser j Clauss fc 
and others have described organisms of this type. They grow read- 
ily on ordinary media with all the characteristics of the colon group, 

a Ann. d. Chim. et Phys., 3 Serie, 1858, 52. 

b Quarterly Journal of Micros. Sc, 1878, 18, p. 177. 

cMitth. a. d. kaiserl. Gesundheitsamt, 1884, 2, 309. 

<*Mitth. a. d. kaiserl. Gesundh. amt., Bd. 2, S. 309. 

« Darmbakterien des Sauglings, Stuttgart, 1886. 

/Erganzungshft. Centrbl. f. Allg. Gesundheitspfl. , Bd. 11, S. 117. 

yFortschr. d. Mediz., Bd. IV, 1889. 

frBerl. klin. Wochenschr. , 1887, S. 631. 

iLandw. Wochenbl. f. Schlesw. Hoist., 1890, 29. 

JAnnal. de l'lnstitut Pasteur, 1894, p. 738. 

fclnaug. Dissert., Wiirzburg, 1889. 



496 

but do not as a rule produce indol. Although known since Hueppe's 
description as the Bacterium acidi lactici this organism is more com- 
monly called Bacterium serogenes. 

The second group includes bacteria described by Clauss (loc. cit.),, 
Gunther and Thierfelder, a Esten, 6 Leichmann, c Kozai/ Schier- 
beck/ Haschmioto/ Harrison and Cumming/ Conn and Esten^ 
Holling/ and VtzJ The characteristic organism is defined as oval 
or lance shape, occurring in pairs or short chains, colored by Gram, 
growing slowly on ordinary media, and producing no gas in presence 
of sugars. The growth on solid media is delicate and translucent. It 
causes rapid acid fermentation of milk, with coagulation. Bac- 
terium lactis acidi, Bacterium acidi lactici, and Bacterium Guntheri 
are some of the terms used to designate this organism. 

The third group includes micrococci described by Grotenfeld (loc. 
cit.) and Weigemann (loc. cit.) as streptococci. The cultural char- 
acters of this group are exactly similar to those of the second, the 
sole difference in the descriptions being in the morphology, in one 
case an oval or lance-shaped bacillus, in the other a streptococcus. 
Kruse^ in 1903 pointed out the close similarity of organisms classed 
in the second and third groups and suggested that the difference of 
morphology was merely one of interpretation, namely, that the oval 
bacillus was a phase in the rapid growth by division of the strep- 
tococcus. Two years later, Heinemann/ after a careful comparison of 
strains of Bacillus acidi lactici from various sources with streptococci 
(sewage, pathogenic, water), concludef that they show no constant 
differences in growth, action on milk, or pathogenicity. Heinemann's 
work has done much to change existing ideas as to the significance of 
streptococci in milk, for he has shown that the most common organ- 
ism of lactic acid fermentation, existing in practically all milk from 
healthy cows, is a streptococcus (S. lacticus, Kruse). Here again, 
as in the case of leucocytes in milk, it does not necessarily follow 
that streptococci when present are associated with disease. It does 
not seem strange that an organism so widely distributed in nature, 

a Archiv. f. Hyg., Bd. XXV, S. 164, 1895. 

b Ann. Report Storrs Agric. Exp. Station, 1896. 

cCentralb. f. Bakt. 1896, Abt. II, Bd. 2, S. 799. 

<*Ztschr. f. Hyg., 1899, Bd. 31, S. 337. 

eArch. f. Hyg., 1900, Bd. 38, S. 294. 

/Hyg. Rundschau, 1901. 

0jour. app. Microsc, 1902, Vol. 5, pp. 20-29. 

ft Ann. Report Storrs Agric. Exp. Station, 1902-3, p. 63. 

*Inaug. Dissert., Bonn, 1904. 

iCentralbl. f. Bakt., 1904, Abt. II, Bd. XI, S. 600. 

fcCentralbl. f. Bakt. Abt. I, Bd. 34, S. 737. 

* Journ. of Infect. Diseases, 1906, Vol. 3, No. 2. 



497 

so common on the skin and mucous membranes, and in the feces of 
animals should be so often found in cows' milk. 

In their studies of leucocytes in smears made from milk, Conn and 
Esten (loc. cit.), Bergey (loc. cit.), Reed and Ward/ and others 
noted the number and frequency of occurrence of streptococci. As 
they regarded the leucocytes as evidence of inflammation, they 
placed a similar construction upon the presence of these micro-organ- 
isms; since streptococci are well known to be a common cause of 
septic infection and pus formation. The recent investigations con- 
cerning the nature of the Streptococcus lacticus, a nonpathogenic 
organism, proving it to be indistinguishable, morphologically, from 
the pathogenic streptococci, show that such a conclusion is often in- 
correct. It is easily conceivable that in cases of garget and in septic 
conditions the streptococci associated with pus in the milk may be 
truly pathogenic. In fact, a number t>f writers in this country and 
abroad have described " outbreaks" following the use of milk con- 
taining streptococci from diseased cows. 

Hoist, 6 Stokes and Wegefarth, c Beck/ Lameris and Von Harre- 
velt/ Kenwood/ Savage/ and many others saw epidemics of sore 
throat with swelling of the cervical glands, colic, diarrhea, and fever 
lasting several days, which were ascribed to the use of milk from 
cows with garget. Such milk when examined was found to contain 
pus and streptococci in great abundance. Hoist in an experiment 
upon himself drank 200 cubic centimeters of a culture of a strepto- 
coccus isolated from such a milk during an outbreak, and became ill 
with colic and diarrhea. 

Petruschky and Kriebel 7 * and Holling* see in the streptococci 
found in milk a cause of summer diarrhea in children. 

As regards the relationship between the numbers of leucocytes and 
streptococci, most writers agree that in mastitis the milk usually 
contains both in abundance. There is a difference of opinion concern- 
ing their relationship in milk from healthy cattle; Bergey and 
Trommsdorff finding a simultaneous increase or diminution, whereas 
Savage and others do not. 

The manifest advantages to be gained from a knowledge of the 
pathogenic or nonpathogenic properties of the streptococci in milk 

a Ref. Centralb. f. Bakt., Abt. 1, 1903, Bd. XXX, S. 83. 
b Ref. Baumgartens Jahresber., 1895, S. 52. 
cMed. News, 1897, vol. 71, No. 2, p. 45. 

^Deutsches Vierteljahrschr. f. offentl. Gesundheitspfl. Heft III, S. 430. 
^Zeitschr. f. Fleisch. u. Milch. HygT, 1901, Bd. 11, S. 114. 
/Brit. Med. Journ. 1904, No. 1, p. 602. 
9 Journ. of Hyg., 1906, vol. 6, p. 123. 

^Die Ursachen der Sommersterblichkeit der Sauglinge u. die Moglichkeit ihrer Ver- 
hutung, Leipzig, 1904. 
* Inaug. Diss. Bonn, 1904. 

45276°— Bull. 56—12 32 



498 

has led to a number of investigations. Injections of milk or cultures 
isolated from milk into the tissues and peritoneal cavities of animals 
gave varying results. In some cases death of the animal ensued. It 
was found that as a rule when the organisms were pathogenic this 
property was gradually lost by cultivation on artificial media, and 
could be increased by carrying through a series of animals. Heine- 
mann a in a recent study succeeded in raising the virulence of a number 
of strains of Streptococcus lacticus, by passage through successive rab- 
bits, from almost nil to an equality with that of the Streptococcus 
pyogenes. Unfortunately the virulence for animals is not a certain 
index of the virulence for man. 

Attempts to distinguish S. lacticus and S. pyogenes by hemolytic 
and agglutinative tests have been made by Schottmuller, 5 Lubenon, c 
Schlesinger, d and Miiller 6 and Bergey (loc. cit.). No constant 
results have been obtained. Muller found that milk streptococci 
were almost as often hemolytic as the S. pyogenes, and heterologous 
strains were more strongly agglutinative than homologous. As has 
been pointed out, no specific characters have been revealed by cul- 
tivation on various media. 

In view of the facts presented the assumption seems justified 
that the Streptococcus pyogenes and the Streptococcus lacticus, the 
common organism of lactic-acid fermentation, are indistinguishable 
by our present methods. 

Briefly, the conclusions which present themselves are as follows: 

(1) Many leucocytes and streptococci are present in the normal 
milk of a healthy cow. 

(2) Leucocytes and streptococci are as a rule more numerous in 
the milk of diseased than in that of healthy cows. 

(3) As an aid to veterinary inspection the number of leucocytes 
may furnish some information of value. If a dairy milk shows an 
unusually high leucocyte count, a special examination of the herd 
for garget, etc., should be made. 

(4) No satisfactory method has been devised for distinguishing 
the pathogenic from the nonpathogenic streptococci in milk. Their 
significance is therefore a matter for further study. 

(5) In view of the recent researches upon Streptococcus lacticus no 
constant relationship may be expected between the number of strep- 
tococci and the number of leucocytes in milk. 

a Journ. of Infect. Diseases, vol. 4, No. 1, 1907, p. 89. 

& Munch. Med. Woch., 1903, T$t. 50, S. 909. 

c Centralbl. f. Bakt., 1902. 

d Zeitschr. f. Hyg., Bd. XLIV, 1903. 

e Archiv. f. Hyg., 1906, Bd. 56, S. 90. 



14. CONDITIONS AND DISEASES OF THE COW 
INJURIOUSLY AFFECTING THE MILK. 



(499) 



CONDITIONS AND DISEASES OF THE COW INJURIOUSLY 
AFFECTING THE MILK. 



By John It. Mohler, A. M., V. M. D., 

Chief of the Pathological Division, Bureau of Animal Industry. 



IMPORTANCE OF A WHOLESOME MILK SUPPLY. 

The reasons for securing a supply of pure and wholesome milk are 
so numerous and so important that the public should become ac- 
quainted with some of the more essential of them in order that assist- 
ance may be rendered in bringing about a satisfactory improvement. 
Public health demands the purity of all milk and milk products. 
Next to bread, milk is more extensively used as an article of diet than 
any other foodstuff. It forms a portion of the food of almost every 
person on practically every day of the year. Furthermore, unlike 
many other articles of diet, milk is consumed in most cases in an 
uncooked state, making it a very dangerous food should it perchance 
contain any deleterious organisms. Not only is milk a very suitable 
medium for almost every description of germ life which may gain 
access to it in its journey from the cow to the consumer, but it may 
also become contaminated while still in the udder through infectious 
or poisonous material present in the cow herself. In this paper, 
however, consideration will be given only to the latter aspect of the 
subject. 

In this connection it will be necessary to keep in mind the require- 
ments of an awakened public for a clean and wholesome milk, as well 
as the effect of any unreasonable or irrational demand upon the 
producer, which may cause him heavy losses or even to discontinue 
his business. It will also be apparent that in order to produce milk 
in compliance with the requirements hereafter described certain pre- 
cautions must be taken, which will necessarily entail additional ex- 
pense upon the producer of this higher grade of milk. The customer 
must therefore expect to pay his portion of any legitimate advance 
in the cost of production, and such increase in the price of milk due 
to its improved quality should be considered as money well expended. 

(501) 



502 

Moreover, good milk of safe quality can not be had without a real- 
ization on the part of the farmer, the transportation agent, the dairy- 
man, and the housewife of the danger in utilizing old, warm, or dirty 
milk. Education is therefore an important factor in the improve- 
ment of the milk supply, which can not be accomplished through laws 
and regulations alone. In view of these facts, it is recommended that 
the subject be taught in the schools, that popular articles be fre- 
quently prepared for the press, that lectures and demonstrations be 
given in towns and townships, that pamphlets in plain language be 
prepared by the health officer for general distribution, and especially 
that rules and suggestions, with reasons therefor, be placed in the 
homes of dairymen and dairy attendants. 

DISEASES WHICH MAY RENDER MILK DANGEROUS. 
TUBERCULOSIS. 

This is probably the most important disease of cows from the stand- 
point of public health, and it is also the most prevalent. When Koch 
first discovered the cause of tuberculosis and combined the announce- 
ment of his discovery with the statement that he considered the 
affection identical in both man and cattle, this view was accepted by 
scientists as well as by the general public. His subsequent announce- 
ment in 1901, to the effect that this disease was different in man and 
in cattle, and that there was no practical need for preventing the use 
of the products of tuberculous animals for human food, was the cause 
of much rejoicing among those who were only too glad to grasp at any 
idea which would tend to separate the disease in man and in cattle, 
forgetting that bovine tuberculosis is also a dangerous disease to other 
cattle in the herd and should be stamped out for this reason aside 
from any danger to man. 

As a result of this radical statement of Koch's, which was based 
upon incomplete and unsatisfactory evidence, several government 
commissions were appointed in different countries, and many private 
and public scientists immediately took it upon themselves to solve the 
question raised by that investigator. The results of these experiments 
were so strikingly similar that it is now the generally accepted opinion 
among scientists that people, especially children, may become infected 
with tuberculosis from cattle. It is not known to what extent such 
infection occurs, nor is it possible to obtain any definite percentage 
by the method formerly adopted of looking for the primary lesions in 
the intestinal canal, although much statistical evidence is recorded, 
showing that even by these figures primary intestinal tuberculosis of 
children has been observed in as high as 45.5 per cent of the tubercu- 
lous cases examined (Heller). Evidence which must be considered 
conclusive has been obtained by the Bureau of Animal Industry, as 



503 

well as by Eavenel and a number of French investigators, showing 
that tuberculous infection may take place through the intestinal tract 
without leaving any lesion in the abdominal cavity, the first alteration 
being found in the lungs or the thoracic glands. Therefore the pres- 
ence of pulmonary tuberculosis in infants without intestinal lesions is 
no indication that the disease was not transmitted by the food, and the 
statistics above referred to are thus shown to be below the true per- 
centage of cases of tuberculosis of intestinal origin. 

EVIDENCE OF TRANSMISSION FROM CATTLE TO PEOPLE. 

These figures, however, do not give any satisfactory idea as to 
whether the bacilli entering the intestines originated from human or 
bovine sources. Owing to this fact it follows that the only way of 
determining the infection of people by bacilli of the bovine type is to 
study the lesions in the body of as many cases of human tuberculosis 
as possible. Already we have sufficient data to give us some idea of 
the extent of tuberculosis of the bovine type in children without con- 
sidering the numerous cases of direct transmission recorded by many 
physicians, especially of instances of butchers and others receiving 
accidental infections of the skin with the bovine organism. More- 
over, according to Yon Behring, the question of infection in man 
usually goes back to childhood, as he believes that many of the cases 
of pulmonary tuberculosis in adults are of intestinal origin, infection 
having occurred primarily through the intestinal tract by drinking 
tuberculous milk during infancy and having remained latent until 
adult life. As vital statistics show that 14 out of every 100 people 
that die succumb to tuberculosis, while of the remaining 86 more than 
one-half show lesions of tuberculosis on post-mortem, although dying 
from some other cause, the foregoing statement of Yon Behring is 
also practically pertinent in regard to the relation of human tubercu- 
losis to the milk supply, especially in connection with the results of 
those investigators who have studied market milk and found from 2.7 
to 55 per cent of the samples examined to contain tubercle bacilli. 

Since direct experiments upon human beings are out of the ques- 
tion, the finding of the bovine type of tubercle bacillus in human 
lesions is the most direct and positive proof that tuberculosis of cattle 
is responsible for a certain amount of tuberculosis in the human 
family. Numerous experiments with this object in view have already 
proven this fact. Thus the German Commission on Tuberculosis 
examined 56 different cultures of tubercle bacilli of human origin and 
found 6 which were more virulent than is usual for human tubercle 
bacilli, causing marked lesions of tuberculosis in the cattle inoculated 
with them, and making over 10 per cent of the cases tested that were 
affected with a form of tuberculosis which, by Koch's own method, 
must be classified as of bovine origin. The bacilli, with the exception 



504 

of a single group, were all derived from the bodies of children under 
7 years of age, being taken from tubercular ulcers in the intestines, 
the mesenteric glands, or from the lungs. 

In a similar series of tests conducted by the British Royal Com- 
mission on Tuberculosis, 60 cases of the disease in the human were 
tested, with the result that 14 cases were claimed by this commission 
to have been infected from bovine sources. Ravenel reports that of 
5 cases of tuberculosis in children 2 received their infection from 
cattle. Theobald Smith has estimated that from 25 to 50 per cent of 
the cases of human tuberculosis starting in the cervical and mesenteric 
lymph glands are bovine in origin, while Park has recently found 4 
cases of bovine infection out of 11 cases of generalized tuberculosis of 
infants, and 3 cases due to the bovine type of bacillus out of 16 cases 
of tubercular adenitis. Of 4 cases of generalized tuberculosis in chil- 
dren examined in the Biochemic Division of the Bureau of Animal 
Industry 2 were found to be affected with very virulent organisms, 
which warranted the conclusion that such children had been infected 
from a bovine source. The Pathological Division of the same Bureau 
has likewise, out of the 9 cases of infantile tuberculosis examined, 
obtained two cultures of tubercle bacilli that could not be differen- 
tiated from bovine cultures. In Europe so many similar instances of 
bovine tubercle bacilli having been recovered from human tissues are 
on record that it appears entirely proven that man is susceptible to 
tuberculosis caused by animal infections, and while the proportion of 
such cases can not be decided with even approximate accuracy, it is 
nevertheless incumbent upon us to recommend such measures as will 
guard against these sources of danger. 

MILK AS A CAKRIER OF TUBERCULAR INFECTION. 

The two principal sources of infection from cattle, and the only 
ones necessary to be considered, are the meat and milk of tuberculous 
animals. The fact that most of the cases of bovine tuberculosis 
above enumerated which occurred in the human occurred in infants 
points with grave suspicion to the milk rather than the meat supply. 
This naturally leads to the question of how and under what condi- 
tion does the milk become dangerous, since Bang, Rabinowitsch and 
Kempner, Ernst, Ravenel, Smith, MacWeeney, Moussu, Gehrmann 
and Evans, Mohler, and many others have definitely determined the 
infectiveness of milk from tuberculous cows. 

That milk coming from a tuberculous udder is capable of trans- 
mitting the infectious principle is conceded by all who have given 

a Ravenel has collected the number of cases of human tuberculosis which have 
been studied with special reference to the type of bacillus causing them, whether 
human or bovine, and states that of the 306 cases reported, 63, or approximately 
20 per cent, were due to the bovine tubercle bacillus. 



505 

the subject any consideration. It has been equally established that 
in advanced generalized tuberculosis the udder may secrete tubercle 
bacilli without showing any indication of being affected. Careful 
experiments performed by trained and eminently responsible inves- 
tigators have also demonstrated beyond reasonable doubt that 
tubercle bacilli at certain times may be present in the milk of cows 
affected with tuberculosis to such a degree that the disease can be 
detected only by the tuberculin test, so that in a herd of cows in 
the various stages of tuberculosis it is to be expected that some of 
them will secrete tuberculous milk, which, when mixed with other 
cows' milk, makes the entire product dangerous. 

In this connection it may be stated that the market milk of the 
District of Columbia has recently been examined by the writer for 
the presence of tubercle bacilli by the intra-abdominal inoculation 
of guinea pigs, and in 2 samples, or 2.7 per cent of the 73 specimens 
tested, virulent tubercle bacilli were recovered. The ease with which 
tubercle bacilli may be eliminated by the udder was strikingly illus- 
trated by an experiment conducted bj T the Royal British Commission, 
in which a cow injected with human tubercle bacilli under the skin 
of the shoulder began excreting tubercle bacilli from the mammary 
gland seven days later, and continued to do so until its death from 
generalized tuberculosis thirty days after inoculation. Furthermore, 
Titze, of the Kaiserliche Gesunclheitsamte, proved that human tu- 
bercle bacilli when injected into the jugular vein of milch cows may 
be excreted with the milk. In the first experiment the excretion of 
the bacilli began in the third week and continued until the 144th day. 
In a subsequent test tubercle bacilli began to be excreted after twenty- 
four hours, but no bacilli could be found after ninety-nine days. In 
both these cows only the milk from the left hind quarter proved to be 
infectious. 

It has been shown by Gaffky and Eber in Germany and Schroeder 
in this country that, even when the tubercle bacilli are not being 
excreted by the udder, the dust and manure of the stable where the 
diseased animals are kept are in many cases contaminated with tuber- 
cle bacilli. This contaminated material may readily infect the milk 
during the process of milking, even though the milk comes from a 
healthy cow. The importance of this method of infecting milk can 
not be too greatly emphasized when it is known that cattle in prime 
condition, without any udder lesions and with but slight alterations 
in the lungs, frequently raise tuberculous mucus into the pharynx 
while coughing, then swallow this material and thus contaminate 
the feces. In a recent examination at the Bureau of Animal Industry 
Experiment Station of the manure passed by 12 cows just purchased 
from dairy farms supplying milk to the city of Washington and 
affected with tuberculosis to an extent demonstrable only by the 



506 

tuberculin test, tubercle bacilli were found in over 41 per cent of the 
cases, both by microscopic examination and animal inoculations. The 
danger from this method of infecting milk is impressed upon us as 
consumers when we consider the prevalence of tuberculosis in dairy 
herds as disclosed by numerous tests. 

PREVALENCE OF TUBERCULOSIS AMONG COWS SUPPLYING MILK TO THE DISTRICT 

OF COLUMBIA. 

Judging from the results of recent tuberculin tests, it is believed 
that on an average between 15 and 25 per cent of all the cows which 
supply milk to the District of Columbia are tuberculous. During 
1907 and the first half of 1908 the Bureau of Animal Industry 
supervised the testing of 2,468 cattle in 128 herds supplying milk 
to the District, with the result that 387, or 15.68 per cent, were found 
tuberculous. Many other tests have been made by local veterina- 
rians of which the Bureau has no records. The percentage given 
is scarcely a fair estimate of the extent of tuberculosis in the dairy 
herds of this vicinity, since our tests include many herds which have 
either been cleaned previously by private tests or which have such a 
healthy appearance as to remove all suspicions of tuberculosis on a 
physical examination. Thus far these tests have all been voluntary 
on the part of the dairymen, and it is pleasing to note the large num- 
ber who have had their herds cleaned of tuberculosis and the prem- 
ises disinfected. 

DANGER FROM TOXIN IN MILK OF TUBERCULOUS COWS. 

Aside from the danger of tubercle bacilli in milk, some investiga- 
tors (Le Blanc, Ripper, Jemma, and De Michele) consider the milk 
of tuberculous cows dangerous even when bacilli are not present, on 
account of the toxin it contains. Michellazzi has injected such milk 
into tuberculous animals and obtained a reaction. 

ELIMINATE TUBERCULOUS CATTLE OR PASTEURIZE MILK. 

To eliminate all tuberculous cattle from the herd or to pasteurize 
all milk coming from untested cattle should therefore be the object 
of all producers of milk, and sanitarians will be remiss in their whole 
duty should they neglect to guard against the products of tuberculous 
animals in their attempts to eradicate tuberculosis from man. This 
view was crystallized in a resolution adopted by the International 
Congress of Tuberculosis recently held in Washington, D. C, as 
follows : 

Resolved, That preventive measures be continued against bovine tuberculosis, 
and that the possibility of the propagation of this infection to man be recognized. 



507 

TUBERCLE BACILLI IN OTHER DAIRY PRODUCTS. 

Since milk is so often infected with tubercle bacilli, it is very evi- 
dent that food products made from milk without submitting it to 
lethal temperatures during the process of their manufacture must 
frequently harbor virulent tubercle bacilli in undesirable numbers. 

The investigations of Eabinowitsch, Klein, Laser, Bang, Petri, 
Dawson, Markl, Moller, and many others have conclusively shown 
that tubercle bacilli may be present in butter, buttermilk, margarin, 
and cheese when these products are offered for sale. Butter made in 
the customary manner and stored under the ordinary market condi- 
tions until time of sale, if dangerous through the presence of tubercle 
bacilli at the time of its manufacture, may retain its virulence through 
several months. This statement has been adequately proved by two 
series of experiments recently performed by the Bureau of Animal 
Industry. 

In one series by Mohler, Washburn, and Eogers three samples of 
butter were tested. The first was made from milk to which bovine 
tubercle bacilli had been added just before churning. They were 
obtained from a luxuriantly growing culture upon glycerin bouillon. 
Ten centigrams were removed from the surface growth of the flask, 
carefully mixed in a sterilized solution, and added to 10 gallons of 
milk. The second sample was made from milk obtained from a cow 
affected with tuberculosis of the udder. In this milk tubercle bacilli 
of extreme virulence were present in great numbers. Both the first 
and second samples of butter were salted in the usual proportions of 
1 ounce of salt to a pound of butter. The third sample was similar in 
every respect to the second, except that it was left unsalted. These 
samples of butter were tested upon guinea pigs, not only when first 
made, but also after storing for ten days in the ice chest, after hold- 
ing in cold storage for sixty days, and again after retention in cold 
storage for a period of five months (one hundred and fifty-three 
days). The results showed that each of these samples harbored viru- 
lent tubercle bacilli throughout the entire storage period, and that at 
any time they were capable of infecting guinea pigs with tuberculosis 
if injected into the peritoneal cavity, and if the tuberculous butter 
was fed to the animals generalized cases of tuberculosis were still 
capable of being developed. In these experiments 10 guinea pigs were 
fed upon each butter sample for three consecutive days and 6 were 
inoculated with the same kind of material. Six weeks later they 
were chloroformed and the visceral organs of each were carefully 
scrutinized that every trace of tuberculosis might be detected. None 
of the lots of guinea pigs remained entirely free of tuberculosis, 
although those animals which were fed upon the contaminated but- 
ter failed to contract the disease as frequently as those which were 



508 

injected. This experiment is to be extended further in order to de- 
termine the maximum time in which infected butter, both salted and 
unsalted, will remain virulent when kept in cold storage under nor- 
mal trade conditions. As the temperature in the cold-storage rooms 
is very low, the evidence shows that the tubercle bacilli are held un- 
changed in the frozen butter for a long period, but that they slowly 
lose their vitality. 

In another series of experiments by Schroeder and Cotton, of the 
Bureau Experiment Station, butter was made from the milk of a cow 
affected with udder tuberculosis. After salting at the rate of 1 ounce 
of salt to a pound of butter, the butter was kept without ice in a cellar 
in which the temperature remained fairly constant at 60° F., and 
from time to time, up to one hundred and sixty days from the making 
of the butter, guinea pigs were inoculated with portions of the 
butter. More than 60 guinea pigs were thus inoculated and, with 
the exception of 5 that died prematurely and 1 that was killed, all 
died of generalized tuberculosis, and the one that was killed was also 
found affected. 

In cheese also tubercle bacilli may become mixed up with the curd 
during the process of manufacture, and they have been shown to re- 
main virulent for over three months. As a result of Galtier's experi- 
ments conducted with cheese, both salted and not salted, which was 
found to contain tubercle bacilli when two months and ten days old 
he concluded that coagulated milk, fresh cheese, and salted cheese 
made from the milk of tuberculous cows may infect man, and that the 
by-products fed to swine and chickens may infect these animals. In 
experiments made in Switzerland to determine the fate of tubercle 
bacilli in cheese it was demonstrated that they died between the 
thirty-third and fortieth day in cheese made after the Emmental 
method, but considerably later in cheese made approximately after 
the Cheddar method. An emulsion of tubercle bacilli was added to 
milk at the same time as the rennet, and cheese was made from the 
milk in the manner required to obtain Cheddar cheese. From the 
time of manufacture average samples of the cheese were taken weekly, 
macerated in sterile water, and filtered. Guinea pigs were inoculated 
with portions of the filtrate, and it was found that the germinating 
power of the tubercle bacilli lasted one hundred and four days, but 
after one hundred and eleven days they were incapable of conveying 
the disease to guinea pigs by inoculation. Harrison concluded that 
these experiments justify the statement that Emmental cheese may 
be eaten with safety, as the period of ripening is much longer than the 
period during which the bacilli become inocuous. Cheddar cheese, 
he states, is seldom eaten under four months from time of manufac- 
ture, and during this period the tubercle bacilli lose their vitality. 
Notwithstanding this, however, the writer recommended the pas- 



509 

teurization of the milk in order to make the cheese absolutely safe. 
In a recent investigation conducted by the writer in cooperation with 
Doane, tubercle bacilli have been demonstrated by guinea-pig inocu- 
lations in cheese one hundred and twenty- two days old, made after 
the Cheddar method. 

In manufacturing margarin the method commonly employed is to 
subject the finely comminuted fat to a temperature not to exceed 50° 
C. for one and one-half hours. Sour milk is then added and the 
whole mass is thoroughly mixed; dairy butter is next added, and a 
certain proportion of oils (cotton, palm, cocoanut, etc.). Enough of 
one or more of these oils is added to lower the melting point to that 
of dairy butter. Hence it will be seen that artificial butter thus 
made may be infected in three ways: First, from the fat secured 
from the original cattle, as tubercle bacilli will withstand a tempera- 
ture of 50° C. for some hours; second, from the butter or soured 
milk that has been added; and, third, from contamination during 
the course of its manufacture. Morgenroth made examinations of 20 
samples of oleomargarin, purchased in the open market, and proved 
the presence of virulent tubercle bacilli in 9 of the specimens. 

Other products which occasionally are consumed by people, but 
are used more extensively as food for live stock, will also serve to 
convey tubercle bacilli from infected milk to those that are allowed 
to consume them. Thus whey from cheese factories and buttermilk 
and separated milk from public creameries are all offenders in this 
respect and have been incriminated, especially in the feeding of 
hogs and calves. 

VALUE OF THE TUBERCULIN TEST. 

The symptoms of tuberculosis in cattle are not sufficiently promi- 
ment except in advanced stages or when superficially located to ena- 
ble one to diagnose this disease by the ordinary methods of physical 
examination. And the cattle may, without showing any clinical 
symptoms, be in such a stage of tuberculosis as to render them capable 
of spreading disease. Indeed, an animal may be fat and sleek, eat 
and milk well, have a bright, glossy coat, and be apparently in the 
pink of condition, and still be passing tubercle bacilli through the 
feces or by an occasional cough, and thus endanger all the healthy 
cattle in the herd. Consequently, such adventitious aids to diagnosis 
as animal inoculation, biological test, serum agglutination reaction, 
and the tuberculin test are made use of in arriving at a definite opin- 
ion relative to the presence or absence of this disease. The value of 
all but the last of these is discounted by the technique required and 
their impracticability, while the tuberculin test is most satisfactory 
and is the best diagnostic agent known for the disease. 



510 

THE ORIGIN OF THE TUBERCULIN TEST. 

Tuberculin was invented by Koch in 1890, and was first used ex- 
perimentally in treating tuberculosis in man. In these cases it was 
observed that its injection was followed by a rise of temperature, 
which led veterinarians to apply tuberculin to suspected animals to 
see if a similar reaction resulted. Numerous experiments showed this 
to be the case, and since 1891 the use of tuberculin as a diagnostic 
agent for tuberculosis of cattle has been almost universally adopted 
in all parts of the civilized world. No one thinks of accepting tuber- 
culin us an absolutely infallible agent, but it is immeasurably more 
dependable than any other method that has ever been used. 

THE NATURE AND APPLICATION OF TUBERCULIN. 

Tuberculin is the sterilized and filtered glycerin extract of cultures 
of tubercle bacilli. It contains the cooked products of the growth of 
these bacilli, but not the bacilli themselves. Consequently, when this 
substance is injected under the skin of an animal it is absolutely 
unable to produce the disease, cause abortion, or otherwise injure the 
animal. In case the injected animal is normal there is no more effect 
upon the system than would be expected from the injection of sterile 
water. However, if the animal is tuberculous, a decided rise of tem- 
perature will follow the use of tuberculin. 

In practice the tuberculin test is applied by first taking a sufficient 
number of temperatures, usually three, at intervals of two hours to 
ascertain the normal variation of temperature of the animal to be 
tested. The dose of tuberculin (which should always be specified on 
the label) is then injected hypodermically between 8 and 10 p. m. on 
the day of taking the preliminary temperatures.* On the following 
day the " after " temperatures are recorded every two hours, begin- 
ning at 6 a. m. and continuing until twenty hours following the 
injection. 

THE RELIABILITY OF THE TUBERCULIN TEST. 

As a result of this method an accurate diagnosis may be established 
in over 97 per cent of the cases tested. The relatively few failures 
in diagnosis are included among two classes of cattle. The first class 
contains those that are tuberculous but which do not react either 
because of the slight effect of an ordinary-sized dose of tuberculin on 
an advanced case of the disease with so much natural tuberculin 
already in the system, or on account of a previous test with tuberculin 
which produces a tolerance to this material lasting for about six 

°The ophthalmo-tuberculin test and the cuti-tuberculin test, as their names 
imply, consist in the application of the tuberculin to the eye and to the scarified 
skin of the animal to be tested. These methods will not be discussed at present, 
as they are still in the experimental stage. 



511 

weeks. The second class includes those that are not tuberculous but 
which show an elevation of temperature as a result of (a) advanced 
pregnancy; (b) the excitement of oestrum; (c) concurrent diseases, 
as inflammation of the lungs, intestines, uterus, udder, or other parts, 
abortion, retention of afterbirth, indigestion, etc.; (d) inclosure in a 
hot, stuffy stable, especially in summer, or exposure to cold drafts or 
rains, or (e) any change in the method of feeding, watering, or 
stabling of the animal during the test. 

Notwithstanding all these possibilities of error, the results of thou- 
sands of tests show that in less than 3 per cent of the cases tested 
do these failures actually occur. In the first class the chances of error 
are decidedly reduced by the skilled veterinarian by making careful 
physical examination and diagnosing these advanced cases, and by 
the injection of double or triple doses into all recently tested cattle, 
with the taking of the after temperatures beginning two hours fol- 
lowing the injection and continuing hourly for twenty hours. In 
the second class errors are avoided by eliminating those cases from the 
test that are nearing parturition or are in heat, or show evidence of 
the previously mentioned diseases, or exhibit temperatures sufficiently 
high to make them unreliable for use as normal. Then, in reading 
after temperatures it is advisable not to recognize as a reaction an 
elevation of temperature less than 2° F., or one which at the same 
time does not go above 103.8° F., and the temperature reaction must 
likewise have the characteristic rainbow curve. (Those cases which 
approximate but do not reach this standard should be considered as 
suspicious and held for a retest six weeks later.) In addition, a satis- 
factory tuberculin must be used ; also an accurate thermometer and a 
reliable syringe in order that a sufficient dose of tuberculin may be 
given. Finally, the number of apparent errors of the tuberculin test 
will be greatly diminished if a careful post-mortem examination is 
made, giving especial attention to the lymph glands. 

This low percentage of failures being the case, cattle owners should 
welcome the tuberculin test not only for their own interest but for 
the welfare of the public as well. Where this method of diagnosing 
the disease has been adopted tuberculosis is gradually being eradi- 
cated, while it is spreading rapidly and becoming widely disseminated 
in those districts where the tuberculin test has not been employed. 
Without its use the disease can not be controlled and the cattle owner 
is confronted with serious and continuous losses ; with its use the dis- 
ease can be eradicated from the herd, a clean herd established, and 
the danger of its spread to man removed. Tuberculin may, therefore, 
be considered a most beneficial discovery for the stock raiser. Strange 
to say, many of these men have been incredulous, antagonistic, or 
prejudiced against the tuberculin test by misinterpreting published 



512 

statements, by incorrect, unsubstantiated^ or exaggerated reports, and 
by alleged injurious effects to healthy cattle. 

Law ° has clearly stated the question when he says : 

Many stock owners still entertain an ignorant and unwarranted dread of the 
tuberculin test. It is true that when recklessly used by ignorant and careless 
people it may be made a root of evil, yet as employed by the intelligent and 
careful expert it is not only perfectly safe, but it is the only known means of 
ascertaining approximately the actual number affected in a given herd. In 
most infected herds, living under what are in other respects good hygienic con- 
ditions, two-thirds or three-fourths are not to be detected without its aid, so 
that in clearing a herd from tuberculosis, and placing both herd and products 
above suspicion, the test becomes essential. 

******* 

In skilled hands the tuberculin test will show at least nine-tenths of all cases 
of tuberculosis when other methods of diagnosis will not detect one-tenth. 

It is perfectly natural that there should be objection to its use 
among those who are not acquainted with its method of preparation 
or its properties ; but it is difficult to explain the antagonism of farm- 
ers who are familiar with the facts connected with the manufacture 
and use of tuberculin. Probably the most popular objection to tuber- 
culin is that it is too searching, since it discovers cases in which the 
lesions are small and obscure. While this fact is admitted, it should 
also be borne in mind that such a small lesion to-day may break down 
and become widely disseminated in a relatively short period. There- 
fore any cow affected with tuberculosis, even to a slight degree, must 
be considered as dangerous not only to the other animals in the herd 
but also to the consumer of her products. 

THE HARMLESSNESS OF TUBERCULIN. 

Furthermore, tuberculin must be considered as harmless for healthy 
animals in view of the results revealed by numerous tests covering 
vast number of animals. And it has also been clearly demonstrated 
that tuberculin interferes in no way with the milking function in 
healthy cattle ; neither in the quantity of milk nor in butter-fat value 
has any variation been detected. 

Nocard and Leclainche 6 state : 

Direct experiments and observations collected by thousands show that the 
tuberculin injections have no unfavorable effect. With healthy animals the 
system is indifferent to the inoculation; with tuberculosis animals it causes 
only slight changes, which are not at all serious. 

° Text Book of Veterinary Medicine, vol. 4, pp. 458, 465. Ithaca, N. Y., 1902. 
6 Les Maladies Microbiennes des Animaux, vol. 2, p. 85. Paris, 1903. 



513 

DISPOSAL, OF AND INDEMNITY FOR REACTING ANIMALS. 

Most of the objections to tuberculin would probably be removed if 
some method of compensation for the reacting animals could be de- 
vised. Thus, in Pennsylvania, where tuberculosis is being eradicated 
with more success than in any other State, and where there are 
usually three times as many voluntary requests on file for the appli- 
cation of the test as can be made, all reacting animals are paid for by 
the State. As the suppression of tuberculosis is a public health 
measure, it would appear perfectly logical for the State governments 
to reimburse cattle owners appropriately for the animals condemned 
and slaughtered. Provision could be made to pay 70 per cent of the 
appraised value of the condemned animals, not to exceed $30 per 
head for common stock or $60 for registered stock. Such legislation 
should also include a requirement for the testing of all cattle coming 
into the State for dairy or breeding purposes. 

All tuberculosis animals should be slaughtered in abattoirs having 
Federal inspection, and the money obtained from carcasses which are 
inspected and passed for food and from the hide and offal of those 
carcasses condemned as unfit for food should be applied as part pay- 
ment on the indemnity for their respective owners. The payment 
of indemnity for tuberculosis animals is a good business policy and 
would do more toward making the tuberculin test popular with cattle 
owners than any other possible action. And as a corollary of the 
latter more testing would be performed and more tuberculous cattle 
would be discovered at the start, but the gradual suppression of the 
disease would soon be manifest, as has been noted in Pennsylvania 
and Denmark. Furthermore, as Stiles has mentioned, if tuberculosis 
can be eradicated from dairy herds with but slight loss to the owner, 
the increase in the price of milk would naturally be inhibited, and 
the children of poor families would consequently be in less danger of 
having this very important article of their diet decreased. 

CONCLUSIONS REGARDING THE TUBERCULIN TEST. 

As a result of the careful study of the tuberculin test Salmon a 
draws the following conclusions : 

1. That the tuberculin test is a wonderfully accurate method of determining 
whether an animal is affected with tuberculosis. 

2. That by the use of tuberculin the animals diseased with tuberculosis may 
be detected and removed from the herd, thereby eradicating the disease. 

3. That tuberculin has no injurious effect upon healthy cattle. 

4. That the comparatively small number of cattle which have aborted, suf- 
fered in health, or fallen off in condition after the tuberculin test were either 

° Yearbook of the United States Department of Agriculture, 1901, p. 592. 
45276°— Bull. 56—12 33 



514 

diseased before the test was made or were affected by some cause other than 
the tuberculin. 

SUMMARY OF DIRECTIONS FOR MAKING THE TUBERCULIN TEST. 

1. Stable cattle under usual conditions and among usual surround- 
ings, feeding and watering in the customary manner. 

2. Make a physical examination of each animal, and give to each 
one some designation by which the animal will be known throughout 
the test. 

3. Take each animal's temperature at least three times at two or 
three hour intervals on the day of injection; for instance, at 2, 5, 
and 8 p. m. 

4. At 8 or 10 p. m. inject a dose of tuberculin under the skin in the 
region of the shoulder, using a sterile hypodermic syringe after dis- 
infecting the skin at the seat of injection with a 5 per cent solution 
of carbolic acid or a similar antiseptic solution. 

5. Tuberculin is not alw T ays concentrated to the same degree, and 
therefore the dose, which should always appear on the label, varies 
considerably. The dose of imported tuberculin is 0.25 c. c. for an 
adult cow, and before injection is diluted with sterile water to 2 c. c. 
The tuberculin made by the feureau of Animal Industry is prepared 
so that it will not be necessary to dilute it, and the dose is 2 c. c. for 
an adult animal. Yearlings and 2-year-olds, according to size, should 
receive from 1 to 1J c. c, while bulls and very large animals may 
receive 3 c. c. 

6. At 6 a. m. on the day following the injection of tuberculin com- 
mence taking temperatures, and continue every two or three hours 
until the twentieth hour after injection, at which time if there is no 
tendency for the temperature to rise the test may cease. 

7. A rise of 2° F. or more above the maximum temperature ob- 
served on the previous day, providing the temperature after injection 
exceeds 103.8° F., should be regarded as an indication of tuberculosis. 
Those cases which approximate but do not reach this standard should 
be considered as suspicious, and held for a retest six weeks later, 
giving double the original dose. 

FOOT-AND-MOUTH DISEASE. 

The recent outbreak of foot-and-mouth disease in Michigan, New 
York, Pennsylvania, and Maryland, which started October 16, 1908, 
has been the occasion of many inquiries regarding the effect of this 
disease upon the milk supply and the danger of its transmission to 
man. A brief discussion of these subjects at this time would therefore 
seem appropriate. 



515 

Foot-and-mouth disease, also known as " aphthous fever," " epi- 
zootic aphtha," and " eczema contagiosa," is an acute, highly infectious 
disease of cattle and other domestic animals the characteristic feature 
of which is the eruption of vesicles on the mucous membrane of the 
mouth and on the skin between the toes and above the hoofs. The 
vesicles rupture, forming erosions and ulcerations accompanied by 
salivation, great tenderness of the affected parts, loss of appetite, 
lameness, emaciation, and diminution in the quantity of milk secreted. 

In the early stages or in a mild attack of the disease the milk may 
present only a few abnormal characteristics, such as a fall in its spe- 
cific gravity to 1023-1025, and the reduction in the quantity of sugar 
and casein. When the disease is fully developed, or about the third 
day, the milk invariably contains inflammatory products of a very 
pronounced character, and the quantity of milk secreted is greatly 
reduced. Cows affected with the malignant form of the disease lose 
practically all of their milk, but if the disease is mild in character the 
decrease will be from one-third to one-half of the usual yield. 

The milk becomes thinner, bluish, and poor in fat. Only in rare 
cases does the fat content increase with the diminution of the milk 
secretion. The casein and sugar content is reduced, but the salt con- 
tent is increased and the acidity diminished. If the udder becomes 
involved the milk has a slimy consistence and is yellowish and vis- 
cous like colostrum. It frequently contains coagulated fibrin and 
blood, so that a considerable sediment forms after standing, while the 
layer of cream which rises is thin and of a dirty color. Occasionally 
no layer of cream is- formed, but the milk appears as a uniform, slimy 
mass of a bad odor, and a repulsive, rancid taste. This slimy con- 
sistence is due to the large quantity of albumen and globulin con- 
tained. The sediment contains leucocytes, desquamated epithelial, 
and broken-down tissue cells in large quantities, besides fibrin and red 
blood cells. 

This affection is transmissible to man through the ingestion of 
raw milk, buttermilk, butter, cheese, and whey from diseased animals, 
and also directly, though more rarely, from the saliva, secretions, or 
other infected material which may gain entrance through the abra- 
sions of the skin. Children are not infrequently infected by drinking 
unboiled milk during the periods in which the disease is prevalent in 
the neighborhood, while those persons in charge of diseased animals 
become infected through contact with the diseased parts as by milk- 
ing, slaughtering, or caring for them. In such cases the symptoms 
resemble those observed in animals. There is fever sometimes with 
vomiting, painful swallowing, heat and dryness of the mouth, followed 
by an eruption of vesicles on the buccal mucous membrane and very 
rarely by similar ones on the fingers. These vesicles appear on the 
lips, gums, cheek, and edge of the tongue, and are about the size of a 



516 

pea. The vesicles soon rupture, leaving a small erosion which is soon 
covered by a thin crust under which the new formation of epithelium 
proceeds rapidly. The skin eruption mostly appears on the hands, 
tips of the fingers, base of the nails, volar surfaces of the finger tips, 
and more seldom on the toes and other parts of the body. Besides these 
local changes, during the course of the disease there are occasionally 
observed headache, pain in the limbs, vertigo, abdominal cramps, 
vomiting, diarrhea, and weakness. The disease is very seldom fatal, 
usually appearing in a very mild form except in weakened children 
in whom an accompanying intestinal catarrh may lead to a fatal 
termination. Those veterinarians who have had considerable experi- 
ence with this disease among animals regard the human affection as 
by no means uncommon in countries where foot-and-mouth disease 
prevails, but the disturbance of health is usually too slight to come 
to the notice of the family physician. The frequency of such infec- 
tion is established by numerous observations which have been recorded 
in the literature of foot-and-mouth disease, showing that human in- 
fection has constantly accompanied the outbreaks among cattle. Val- 
entin was probably the first to suggest the infectiousness of the milk 
and the transmissibility of the virus to man through the milk of dis- 
eased animals. He reported several cases where people became in- 
fected during the outbreak in Hesse in 1695. Sagar, in 1765, reported 
a similar infection of men in Moravia from drinking infected milk. 
In 1778 all the residents of an Austrian monastery developed a vesicu- 
lar eruption in the mouth after drinking virulent milk. Hertwig, 
Mann, and Villain conducted an experiment on- themselves in 1834 
by drinking milk warm from a cow which was suffering from an 
attack of foot-and-mouth disease. Five days later vesicles appeared 
on the hands, fingers, tongue, cheeks, and lips of Hertwig, while the 
eruption in the other two was confined to the buccal mucous mem- 
brane. 

Allbutt observed the vesicular eruption in the mouths of three 
children in Yorkshire during the English outbreak in 1883, and 
obtained information of a number of similar cases in the community. 
During the 1893 outbreak in Germany a shepherd infected himself 
by holding in his mouth a knife which had been used in paring the 
diseased feet of his sheep. A number of milkmaids were infected 
through milking, the vesicles appearing principally on their hands. 
A child fed on unboiled milk of affected cows developed an erup- 
tion of blisters on the tongue, lips, and soft skin between the fingers 
and toes. Furthermore, in the Berlin outbreak of 1895 a number 
of those who drank infected milk developed fever, followed by the 
formation of vesicles on the tongue and lips. The acute disease 
lasted about five days, leaving a feeling of great weakness for some 
time. Virchow made an investigation of these cases and unhesitatingly 



517 

pronounced the affection to be foot-and-mouth disease. A collection 
of the cases of transmission of this disease to man through the con- 
sumption of milk has been prepared by Wurzburg, while the work 
of Brussenius & Siegel contains a full bibliography of the literature 
of such transmission up to 1896. Similar cases of infection resulting 
from the use of butter made from infected milk are on record, while 
Schneider mentions instances where human infection followed the 
consumption of infected cheese. Similarly, Freidberger & Frohnei 
record cases which were caused by infected buttermilk. 

There have been but few outbreaks of the disease in the United 
States, and therefore recorded cases of its transmission to man in 
this country are quite rare. Law reports having observed the 
disease in man from drinking infected milk during the epizootic of 
1870 in the Eastern States, but the outbreaks of 1880 and 1884 affected 
such a small number of animals and was so quickly suppressed that 
no instance of its transmission to man was recorded. A few cases 
have been reported by Brush a accompanying the New England 
outbreak of 1902. Similar reports have likewise been received 
regarding the appearance of vesicular eruptions in the mouths of 
children during the 1908 outbreak, and the history of these cases 
incriminates the milk consumed. In both of these last outbreaks 
the sale of milk was stopped as soon as the disease was found among 
cattle, and therefore the opportunity for the infection of man was 
not so good as when the disease is more widespread, affecting prac- 
tically all the cattle of the country. In some instances, however, 
the people used the milk after pasteurization, thus avoiding the 
possibility of infection, or the milk was discarded after having been 
rendered harmless by the addition of formalin. 

Foot-and-mouth disease has only made its appearance in the 
United States on the above-mentioned occasions, having always been 
introduced from some foreign country. Its spread among cattle is 
very rapid, owing to the highly infectious character of the virus, 
but fortunately every outbreak upon American soil has thus far 
been quickly followed by its total suppression. 

The method of eradicating the outbreaks in 1902 and 1908 con- 
sisted in the rigid quarantine of all infected premises and the animals 
upon them, in slaughtering the diseased and exposed animals at the 
earliest practicable moment, and in thoroughly disinfecting the 
stables and the contents of the buildings in which they had been 
sheltered. In this manner the disease was confined in both out- 
breaks to but four States and was completely eradicated in a com- 
paratively short time in each instance. 

The causative agent of this disease has not been isolated, although 
numerous attempts have been made to cultivate and stain it. The 

a Journal of American Medical Association, vol. 40, p. 1700, June 20, 1903. 



518 

experiments of Loeffler & Frosch in 1898 have shown that the virus 
will pass through the finest Chamberlancl filter, thus indicating its 
ultramicroscopic size and the reason it has not been detected by 
staining methods. They inoculated experiment animals with this 
filtrate free from all indications of bacterial growth and transmitted 
the disease through a series of animals. These results have since been 
confirmed by other investigators. Observations which have been made 
upon the viability of this filterable virus led to the conclusion that 
the contagion is quite readily destroyed, and milk which has been 
pasteurized for the elimination of tubercle and typhoid bacilli will 
not prove capable of transmitting the disease to persons or animals 
fed with it. Experiments which have been made in recent years 
proved that the contagion will lose its virulence after fifteen minutes 
exposure at 50° C, by being heated for ten minutes at 70° C, while 
exposure to 100° C. destroys it at once. 

The following disinfectants will destroy the virus in one hour: 
Ordinary whitewash; 1 per cent solution of carbolic acid; 3 per cent 
solution of soda, and 1 per cent solution of muriatic acid. 

On the other hand, the resistance of the virus to the influence of 
low temperatures is quite marked, and the infected lymph will retain 
its activity for at least a month when placed in a refrigerator, while 
exposure to a temperature of minus 48° C. for about three hours 
did not destroy its virulence. Infectious milk three or four days 
old, after having turned sour, or milk to which rennet has been added, 
is not capable of transmitting the contagion In fresh cattle or 
swine manure the infectious material is very soon destroyod at a 
depth of over 1 foot, owing to the heat developing therein in conse- 
quence of decomposition and reaching about 70° C. 

The experiments which have been made in Denmark and Germany 
indicate that the form of pasteurization recommended in article 20 
of this bulletin is undoubtedly sufficient to kill the infectious prin- 
ciple of foot-and-mouth disease. 

ACTINOMYCOSIS. 

This disease, while not at all infrequent in the maxillary regions of 
cattle, is quite rarely located in the udder. It is readily mistaken 
for tuberculosis, owing to the diffuse lesions and the character of the 
pus. While no known case of actinomycosis in man has been traced 
to the milk, it is nevertheless advisable to condemn the milk from 
an infected udder, especially since the virus of the disease in man, in 
most cases, has been found to enter the body through the alimentary 
canal. Furthermore, there is usually in actinomycosis a mixed in- 
fection with pus-producing cocci, which emphasizes the necessity for 
prohibiting the use of the milk from such udders. 



519 

BOTRYOMYCOSIS. 

Botryomycosis of the udder is only occasionally met with, but 
when it is observed the utilization of the milk therefrom should not 
be permitted. The disease is chronic and is accompanied by new 
connective tissue formation and burrowing sinuses from which pus 
escapes. Mixed infection is liable to occur in this disease also, which 
adds to the danger of consuming the milk. 

ANTHRAX. 

In this disease the milk has an abnormal appearance and decom- 
poses rapidly. The bacterium of anthrax has been recovered from 
milk fourteen days after it had been taken from an infected cow, 
which illustrates the importance of prohibiting the use of milk from 
such animals. 

COWPOX. 

This disease, which is probably becoming more common in this 
country, renders the milk unfit for food, and its distribution from 
cows so affected should not be permitted, inasmuch as the milk may 
become contaminated from the pustules and ulcers on the teats and in 
the sinuses of the udder, and produce infection by the alimentary 
canal of young children if it is consumed in a raw state. 

The appearance of dark-brown crusts on the teats and udders of 
cattle is suggestive of several conditions and should be carefully ex- 
amined, particularly since the isolation by Dean and Todd of an 
organism identical with the Klebs-Loeffler bacillus from such lesions 
as well as from the milk. Diphtheria is not a disease of cattle, but it 
is possible for an abrasion to become infected with this organism 
from a human origin and the local lesion to spread until it involves 
the milk sinuses. It was also suggested that this udder lesion might 
be due to an infected milker following the all too common habit of 
spitting on his hands before commencing to milk, and the bacillus 
passing up the milk duct might thereby infect the sinus. 

RABIES. 

The virus of rabies has in several instances been reported to have 
been passed to the offspring through the mother's milk. While it is 
not probable that cattle would be milked after the symptoms of rabies 
developed, it is nevertheless important to realize the danger of using 
such milk and the necessity for preventing calves from sucking such 
diseased cows. 



520 



This disease or series of diseases of the udder is by far the most 
frequent alteration noted. Usually only one quarter is affected, 
although the whole udder may at times be involved. The affected 
parts are greatly swollen and more or less painful in the early stages. 
The milk, at first normal in appearance, soon changes its character, 
becoming watery, light brown in color, and in some cases contains 
flocculi and pus cells, and appears tenacious, slimy, or ropy. The 
cause of this condition is usually a streptococcus, although staphylo- 
cocci are frequently incriminated in suppurative conditions of the 
udder, especially where abcess formation occurs. The milk from 
such an udder is objectionable from an esthetic standpoint and is also 
liable to give rise to gastro-intestinal disorders, especially in children. 
Such milk should be prohibited until the inflammatory condition 
entirely disappears. 

LEUCOCYTES IN MILK. 

The number of leucocytes in milk and their significance are receiv- 
ing the serious attention of those bacteriologists who are striving for 
a purer milk supply. The question as to what number of leucocytes 
should be regarded as abnormal is still the subject of investigation, 
but the opinions of contemporaneous workers are becoming more uni- 
form as the methods for the determination of these leucocytes are 
reaching greater perfection. Previously it was considered that but 
few leucocytes were contained in the milk of healthy cows, and when 
a certain increased number of leucocytes were observed in milk it was 
suggestive of inflammation of the udder, termed mammitis or garget. 
As the milk in this disease may contain pus without changing the 
appearance of the product, such milk may readily be accepted by the 
consumer as normal. It is therefore of importance to be able to 
designate the cows and the milk so affected, especially as the causative 
agents of this condition are micrococci, which likewise produce intes- 
tinal disorders when consumed by infants. Even when the udder 
inflammation is slight an increase in the number of leucocytes se- 
creted in the milk may be observed, and it was the recognition of this 
fact which has caused the introduction of microscopic examination 
of the milk for the determination of the presence or absence of garget. 
However, with the technique at present employed in the numerical 
determination of leucocytes there is too narrow a margin between the 
leucocytes found in the milk of healthy and those in diseased cows to 
make this form of diagnosis satisfactory and practicable. This is 
particularly true of milk from healthy cows during the first week of 
lactation, although at this time the normal increase of leucocytes 
would be accompanied by colostrum corpuscles. While the several 



521 

methods recommended by different investigators are not directly com- 
parable, it is nevertheless evident that an entire lack of harmony 
exists at present among them which makes the reliability of one or 
more of the methods at least doubtful. The Doane-Buckley and 
Trommsdorff methods are probably the most preferable, but neither 
of these is perfect and should not be depended on per se for the deter- 
mination of udder inflammations by the examination of market milk 
or even the mixed milk of a herd. 

Recently Russell and Hoffmann ° have presented an improvement in 
the technique for determination of the leucocyte content of milk. 
Their experiments show that many leucocytes are not recovered in the 
sediment after centrifugalization by the usual methods, and that it is 
necessary to heat the milk to a point where the creaming power is so 
greatly diminished as to alter the physical arrangement of the fat 
globules. In this manner practically all the leucocytes which were 
enmeshed are liberated and thus enabled to be thrown down and 
recovered in the sediment. These observers used the Doane-Buckley 
quantitative method with milk which had been heated momentarily 
at 70° C. and obtained a count which was in some cases as much as 
four times greater than that secured from the same lot of milk un- 
heated. This increase is usually so marked that it is far beyond the 
limits of analytical error, and, furthermore, such error is reduced to a 
minimum by this method of determination. These experiments have 
opened up an interesting line of investigation, and the limits of lactic 
leucocytosis, which have been adopted by some States, based upon the 
old standards, must be modified accordingly. Since it has been found 
that the heating of milk is absolutely essential in obtaining a some- 
what definite idea of the number of leucocytes in milk, and inasmuch 
as this improvement in the technique, which is as necessary as any 
other part of the process, results in a much higher count than has 
heretofore been observed in any of the previously described methods, 
it is evident that there must be a higher leucocyte standard applied 
for judging milk than has obtained in the past. Milk inspection may 
be greatly benefited by the establishment of some rational standard 
for the leucocyte content of milk, but more study must be given to this 
subject in order to obtain the desired knowledge. 

GASTRO-ENTERITIS. 

The milk of cows affected with gastro-enteritis is of an abnormal 
character, being watery, of bitter taste, and changes quickly to a 
" sweet curdle." This milk is liable to produce digestive disturbances 
in the consumer and should not be utilized. 

a American Journal of Public Hygiene, p. 285, August, 1908. 



522 

MILK SICKNESS. 

A rather peculiar disease, called " milk sickness," is found in the 
central part of the United States, where it at times occurs as an epi- 
demic among cattle and people. In cattle the first indication of dis- 
ease is dullness, followed by violent trembling and great weakness, 
which increases during the succeeding day until the animal becomes 
paralyzed and dies. Through the ingestion of flesh, milk, or dairy 
products of an affected animal the disease is transmitted to man or to 
another animal, and attacks produced in this way most frequently 
prove fatal. In man the disease develops with marked weariness, 
vomiting, retching, and insatiable thirst. Respirations become la- 
bored, peristalsis ceases, the temperature is subnormal, and the patient 
becomes apathetic. Paralysis gradually follows and death takes place 
quietly without rigor mortis. 

Many efforts have been made to elucidate the question regarding 
the nature and cause of this disease, but although many theories have 
been discussed none of them has so far been generally accepted. Some 
investigators hold that the disease is of micro-organismal origin, some 
that it is due to autointoxication, while others think it is caused by 
vegetable or mineral poisons. All seem to agree, however, that the 
disease is limited to low, swampy, uncultivated land, and that the 
area of the places where it occurs is often restricted to one or a few 
acres. Furthermore, when such land or pastures have been cultivated 
and drained the disease disappears completely. 

The discovery of a new focus of this disease in the Pecos Valley 
of New Mexico in November, 1907, gave Jordan and Harris the 
opportunity of studying this peculiar affection by modern bacterio- 
logical methods. As a result they have succeeded in isolating in 
pure cultures from the blood and organs of animals dead of this dis- 
ease a spore-forming bacillus which they name "Bacillus lactimorbi." 
With this bacillus they have reproduced in experiment animals the 
symptoms and lesions peculiar to milk sickness or trembles, and from 
these animals the same organism has been recovered in purity. It 
therefore appears to have been demonstrated that the bacillus in 
question is the actual cause of the disease. As Jordan and Harris 
have already indicated, more comprehensive studies, based on a 
larger supply of material, are desirable in order that the many ob- 
scure and mystifying features connected with the etiology of this 
rapidly disappearing disease may be elucidated. 

From the above facts it seems evident that milk sickness is an 
infectious disease communicable to man, and the cattle owners should 

°The Journal of the American Medical Association, Vol. L., No. 21, May 23, 
1908. 



523 

therefore not be permitted to make use of the meat or milk of affected 
animals for human consumption.® 

SEPTIC OR FEBRILE CONDITIONS. 

The presence in the dairy of cows affected with such septic condi- 
tions as puerperal sepsis, septic metritis, diffuse phlegmon, suppura- 
tive wounds, and extensive ulcerations constitutes a grave danger to 
the milk supply, inasmuch as the milk may become infected with the 
pus-producing organisms, among which the streptococci are capable 
of causing enteritis in man. The milk of cows suffering from febrile 
conditions, especially when associated with sepsis, should also be 
excluded. In the case of small single wounds which cease to sup- 
purate, the milk may be used without danger, providing the teats and 
udder are well cleaned before each milking. 

ABNORMAL APPEARANCE AND CONDITIONS OF MILK. 

The udder acts as a natural emunctory, like the kidney, and in 
consequence of its natural selective powers certain active principles 
contained in various foods, drugs, and poisons are eliminated thereby. 



SLIMY 



These conditions of the milk are not an uncommon occurrence and 
sometimes are produced by a diseased condition of the udder of the 
cow, although in the majority of cases these abnormal appearances of 
milk are caused by various kinds of bacteria infecting the milk after 
it has left the udder. While this altered milk may be perfectly 
wholesome, it is nevertheless unpalatable, and most consumers in this 
country would rather do without than drink such material. 

BITTER MILK. 

This condition in the milk is second in importance onry to the 
slimy milk and causes much trouble to the dairyman. Bitter milk 
may originate from two different sources. The first source is de- 
pendent upon the cow, while the second is due to the growth of 
bacteria in the milk after it has been drawn from the animal. The 
difference between these two classes of bitter milk is that the first 
has a decidedly bitter taste when freshly drawn, while the second 
class is sweet when taken from the cow, but the bitterness occurs after 
standing for a short time and increases in intensity. Only the former 
will be dealt with here. Bitter milk, when produced in the cow, may 

a For further discussion of this subject see article No. 6, this bulletin, by Dr. 
G. W. McCoy, 



524 

result from improper feeding with such herbs as lupines, wormwood, 
etc., or with raw Swedish turnips, cabbages, etc. Bitter milk may 
also be observed during the late stage of lactation and has followed 
the infection of teat ducts with bacteria which act on the proteids as 
an enzyme, converting them into peptones and other products to 
which the bitter taste is probably due. 

COLORED MILK. 

Eed milk may be produced by the effects of bacteria, but is usually 
the result of mixture of blood with the milk, due to an abrasion 
of the udder or teats or to some other traumatism of the udder. It 
may also be due to the cow eating material containing a large amount 
of silica, as sedges, rushes, etc., or to plants containing red pigment, 
as madder root. Other plants which are said to impart color to 
milk are alkanet, field horsetail, meadow saffron, and knot grass. 
Bacillus cyanogenes, the cause of blue milk, at times gets into the 
udder through the milk ducts and leads to a bluish discoloration of 
the secretion. 

TASTE AND ODOR. 

The flavor of milk is very readily affected by the character of the 
feed, as, for instance, by turnips, garlic, wild onions, moldy hay and 
grain, damaged ensilage, and distillery grain. The latter is said to 
cause hyperacidity of the urine and consequent eczema. With proper 
precautions, however, these substances can be fed to dairy cattle with- 
out producing ill effects in the milk. The deleterious substances ex- 
creted with the milk are usually volatile oils contained in the food. 
They are found in the milk as well as in the body, generally in the 
largest quantity during the digestion of the food containing them, 
being eliminated rapidly through the various excretory channels. 
Thus, if these substances are fed eight or ten hours before milking, 
or if cattle in the spring are removed from the pastures containing 
garlic this length of time before milking, there will be little or no 
danger of contaminating the milk. Overkept, fermented, and soured 
feeds tend to produce acidity and other changes in the milk. Swill, 
spoiled gluten meal, and ensilage put up too green are all more or 
less injurious to milk. Distillery swill, in addition to the bad flavor 
which it gives the milk, may cause the secretion of small quantities 
of alcohol in the fluid. That such alcoholic milk is deleterious to 
children as well as to the calves and lambs fed on it is a well-known 
and accepted fact. 

Milk is also modified very sensibly by the use of certain medicines, 
and the list of drugs which are excreted in the milk and give it an 
abnormal odor or flavor or render it deleterious to the consumer is 



525 

4 

quite lengthy. Among the more important may be mentioned opium, 
all volatile oils, purgative salts, rhubarb, arsenic, mercury, lead, zinc^ 
iron, creolin, scammony, iodin, potassium iodid, antimony, bismuth, 
ammonia, and certain acids. 

POISONOUS MILK. 

Toxic properties may be manifested in the milk of cows that have 
eaten certain poisonous plants. Thus poison ivy (Rhus toxicoden- 
dron) produces a condition in cattle during which the milk is capable 
of producing in the consumer severe gastro-intestinal symptoms with 
weakness. Leaves of the common artichoke are also said to produce 
certain toxic properties in the milk which result in abdominal pains 
and diarrhea in the person consuming it. 

COLOSTRUM. 

Milk should not be used within fifteen days of parturition or dur- 
ing the first five days after parturition. All cows should be dried off 
at least fifteen days before calving, not only for the sake of the 
animal, but also on account of the poor quality of such milk at that 
time. This milk before and after parturition is called " colostrum," 
and is a yellow, viscid fluid of a strong odor, bitter taste, and acid 
reaction. The ingestion of such milk is liable to produce diarrhea, 
colic, and other digestive disturbances. 

RECOMMENDATIONS. 

In view of the facts above enumerated the following recommenda- 
tions are made as a basis for laws and for regulations by public health 
officers : 

1. That all cows on dairy farms producing milk for market pur- 
poses be tagged, tattooed, or otherwise marked for identification. 

2. That all milk produced on such dairy farms shall either come 
from tuberculin-tested cattle, which shall be retested at least once a 
year, or be subjected to pasteurization under the supervision of the 
health authorities in case the herd is not tuberculin tested. 

3. That no additions to any herd, whether the herd has been tested 
or not, shall be made in the future without subjecting the additional 
cattle to the tuberculin test. 

4. That no license for the sale of milk shall in future be granted 
except to applicants having herds free of tuberculosis. 

5. That the milk of cattle showing any of the udder affections 
above mentioned, or anthrax, rabies, gastro -enteritis, septic condi- 
tions, or clinical symptoms of tuberculosis, shall not be utilized as 
human food, even though the milk be pasteurized. Milk from cows 



526 

fifteen days before and five days after parturition and that from 
animals receiving any of the deleterious medicaments or foodstuffs 
previously mentioned shall likewise be excluded. 

6. That veterinary inspectors of the health department make fre- 
quent visits to dairies having untested herds, in order that they may 
discover all advanced cases of tuberculosis, or udder tuberculosis, as 
early as possible. 

7. That the various States pass laws granting an appropriate in- 
demnity to all owners of tuberculous cattle which come under their 
respective jurisdiction, the said animals to be slaughtered in abattoirs 
having Federal or other efficient inspection. 



15. THE RELATION OF THE TUBERCULOUS COW TO 
PUBLIC HEALTH. 



(527) 



THE RELATION OF THE TUBERCULOUS COW TO PUBLIC 

HEALTH. 



By E. C. Schroeder, 

Superintendent Experiment Station, Bureau of Animal Industry, Department 

of Agriculture. 



Under the conditions of our present civilization the dairy cow fills 
a unique place ; her living body is the source of the most important of 
all human foods ; she has become an essential factor among our mod- 
ern institutions ; remove her and either a substitute must be found or 
many thousands of young children will die of starvation. The woman 
who can feed her infant at her own breast until it is old enough to 
thrive without milk is nearer the exception than the rule, so that 
either the cow or some other milk-producing animal must, as a sheer 
necessity, be available to serve the purposes of a human foster mother. 
After children have passed the period during which milk is a requi- 
site article of food, most of them continue its use as a beverage and 
add butter to their diet as a second product from the cow. Later on 
cream and cheese are added, and the use of milk to some extent as a 
beverage, and of cream, butter, and cheese as regular, current articles 
of food, is continued to the end of life. Hence, even if we are not 
greatly influenced by the idea that it is disgusting and barbarous to 
eat substances that are obtained from the living bodies of diseased 
cows, Ave must feel that it is important to make a careful inquiry re- 
garding the transmissibility to ourselves, through the use of dairy 
products, of the commonest disease with which dairy cows are af- 
fected. The need for this inquiry is emphasized by the knowledge 
that the commonest and most important disease of cows is also the 
commonest and most important disease of mankind, and by the fact 
that though the disease in question, tuberculosis, is one of the few in- 
fectious diseases to which widely different species of animals are sus- 
ceptible, its commonest victims are persons and dairy cows. 

The indispensable cause of tuberculosis is the multiplication of 
tubercle bacilli in the animal body. Bacilli do not grow and multi- 
ply in animal bodies until they have been introduced into them from 

45276°— Bull. 56— 12 34 (529) 



530 

without, and tubercle bacilli grow and multiply nowhere else in 
nature. The propagation of tuberculosis therefore depends upon the 
tubercle bacilli that emanate from the bodies of tuberculous individ- 
uals, human and animal, and the widespread and common occurrence 
of tuberculosis is due to the unguarded and dangerous expulsion and 
dissemination of tubercle bacilli by the victims of tuberculosis. This 
is the basis for the practically unanimous conclusion among those who 
are informed on the subject, that in our fight for the suppression and 
eventual eradication of tuberculosis we must strive to control and 
make harmless all the sources from which tubercle bacilli are scat- 
tered. 

As persons and dairy cows are the commonest subjects of tubercu- 
losis they are also the commonest sources from which tubercle bacilli 
emanate, and as the exposure of persons to persons through the ordi- 
nary routine of life, and the exposure of persons to dairy cows 
through the lifelong use of dairy products, are more direct and inti- 
mate than the exposure of persons to other possible sources of tuber- 
culous infection, we may conclude that the two most important 
sources of tubercle bacilli against which public health must seek to 
defend itself are tuberculous persons and tuberculous dairy cows. 
Of these two sources the former is probably the more important, but 
only little can be said about it here, as the latter is the subject of this 
article, and the little that is permissible must be limited to the infec- 
tion of dairy products when they are exposed to tuberculous or con- 
sumptive persons. 

Persons affected with tuberculosis of the respiratory passages, the 
lung, throat, etc., expel tubercle bacilli with their sputum and with 
the particles of fluid sprayed from their mouths and noses during 
accelerated expiratory acts. Such persons are not necessarily dan- 
gerous to public health when they observe a number of simple pre- 
cautions relative to the disposition of the infectious material they 
expel from their bodies, but they can not keep their environment 
sufficiently free from tubercle bacilli to make it a safe place for the 
exposure of food that is to be eaten by others. Dairy products are 
usually eaten in a raw state ; that is, without previous exposure to a 
germicidal process like cooking, and hence it is especially desirable 
that they should not be handled by, and should not be exposed in the 
environment of, tuberculous persons. 

The expulsion of tubercle bacilli by those who are affected with 
tuberculosis and the mode of its occurrence justify the enforcement 
of health regulations that will exclude all tuberculous persons from 
serving in occupations like food vendors, cooks, waiters, milkers, 
creamery employees, butter makers, etc. 

A clear conception of the danger to which public health is exposed 
through the use of food products derived from tuberculous dairy 



531 

herds requires that we should have some knowledge on the following, 
special subjects, which will be discussed in order: The character of 
tuberculosis as a disease of cattle; the manner in which tubercle 
bacilli are expelled by tuberculous cattle; the general appearance of 
tuberculous cattle that expel tubercle bacilli; how tubercle bacilli 
from cattle get into milk and other dairy products ; the virulence and 
vitality of tubercle bacilli in dairy products ; the proportion of tuber- 
culous cows among those in use for dairy purposes; and, finally, the 
frequency with which dairy products have been proven under existing 
conditions to contain tubercle bacilli. 

THE CHARACTER OE TUBERCULOSIS AS A DISEASE OF CATTLE. 

Tuberculosis of cattle, as of persons, may be acute and rapidly 
progressive and run its course quickly from infection to death. This 
is rare. As a rule, it is insidious, chronic, and slowly progressive, and 
the bodies of its victims are able to adapt or adjust themselves to 
the gradually increasing, destructive changes it causes until quite 
extensive harm has been done or vitally important organs have be- 
come seriously involved. The result is that the disease may be pres- 
ent in the body a long time without external manifestations of its 
existence. It may attack any part of the bod}^ singly and remain 
confined to it or it may attack several or many parts simultaneously 
or successively. Its favorite location in the bodies of cattle, as in 
those of persons, is the lung. 

The tuberculous lungs of cattle do not show the decided cavity 
formation seen in human tuberculous lungs, but cavities in direct 
communication with the exterior of the body through bronchial tubes, 
more or less completely surrounded by heav'y, dense, connective- 
tissue walls, are common. The dissimilarity of the lesions in the 
lungs of persons and cattle are no doubt the result of normal, anatom- 
ical differences. The lungs of cattle, unlike those of persons, have 
very decidedly outlined lobules, which are separated from each other 
by webs of loose, elastic, connective tissue. This tissue is so abundant 
that it admits of a serous and cellular infiltration through which 
the lobules may be separated from each other as much as a sixteenth 
or even an eighth of an inch, and consequently not only pulmonary 
tuberculosis, but most lung diseases of cattle and other ruminants, 
have a special, distinct character. 

Tuberculosis is more effectually concealed in the bodies of cattle 
than in those of persons, and we all know how long a diagnosis with 
persons may remain in doubt. Perception, or the faculty of receiv- 
ing impressions, is keenest where the nervous system has the highest 
development. Persons, though their perception of pain is much 
keener than that of lower animals, complain little during the earlier 



532 

stages of tuberculosis, because, we may assume, they experience little 
pain or distress. Cattle, with their lower perception and compar- 
atively insignificant means to express suffering, do not complain at 
all because of the pain and distress tuberculosis causes them. 

The frequency with which tuberculous subjects cough depends 
largely upon perception, or sensations in their lungs and throats 
that prompt them to cough. Cattle, shown on autopsy to have ex- 
tensive, advanced, tuberculous lesions of the lung, though observed 
long periods of time before their death, were found to cough only a 
little more frequently than cattle shown on autopsy to have healthy 
lungs. When tuberculous cattle cough it is usually a single, accel- 
erated expiratory effort, or at most two or three such efforts in suc- 
cession, which is sufficient to raise the material that has accumulated 
in their larger air passages far enough into their mouths to be swal- 
lowed. Expectoration, which is common with persons, does not oc- 
cur, and paroxysms of sustained coughing, also common with per- 
sons, are very rare and occur only during the last stages of pulmonary 
tuberculosis. 

The bodies of all animals are stronger and more capable, as a whole 
as well as in their individual parts, than the ordinary vicissitudes of 
life require them to be. The difference between the actual strength 
and capability and that ordinarily required is known as the factor 
of safety. The rarely interrupted, placid routine of a cow's life 
enables her to derive full benefit from the factors of safety in her 
body when she becomes affected with a slow, chronic disease like tuber- 
culosis, the lesions of which are circumscribed in the sense that they 
do not seriously affect parts of the body remote to those in which 
they are located; hence the factors of safety greatly help to prevent 
tuberculous disease in the bodies of cows from showing itself by 
external symptoms. An example of this is seen in illustration No. 15, 
which shows a cow affected with advanced tuberculosis. 

The tuberculous disease of the cow represented in the picture is 
partly located in the glands of her throat ; the enlarged glands press 
on and narrow the passage through which air reaches her lung to 
such an extent that she almost dies of suffocation when she is driven 
a short distance at a moderately fast walk. The general condition 
of the cow shows that the opening through which the air she breathes 
must pass is still large enough for ordinary purposes; the difference 
between its original and its present size is a factor of safety that has 
been almost wholly lost. 

We may conclude that, with few exceptions, the character of tuber- 
culosis among cattle is that of an effectually concealed disease, the 
detection of which before it is well advanced and has done great 
harm is practically impossible through the agency of our unaided 
powers of observation. 



533 

Fortunately we have in the substance known as •" tuberculin " an 
excellent agent for detecting tuberculosis in cattle when all other 
means of diagnosis fail. 

THE MANNER IN WHICH TUBERCLE BACILLI ARE EXPELLED BY 
TUBERCULOUS CATTLE. 

Examinations made at the experiment station of the United States 
Bureau of Animal Industry showed that tuberculous cows expel 
tubercle bacilli more commonly with their feces than in other ways. a 
They also expel them with the material drooled and slobbered from 
their mouths during feeding and ruminating; with the particles of 
fluid sprayed from their mouths and noses during accelerated expira- 
tory acts ; and directly with their milk when their udders are affected. 
Some authorities assert that tubercle bacilli are expelled directly with 
the milk when the udder is free from disease, but the observations 
of the experiment station indicate that this does not occur unless 
cows are affected with otherwise generalized, advanced tuberculosis. 

Milk infected directly through the udder is exceedingly dangerous, 
because the tubercle bacilli it contains are numerous and of the fresh- 
est and most virulent kind. Prof. V. A. Moore, of Cornell Univer- 
sity, says: 

It has been shown from all. examinations that have been reported of milk 
from tuberculous cows that about 15 per cent of them give off tubercle bacilli 
with their milk during the course of the disease. The udders show tuberculosis 
in about 2 per cent of the cases. 6 

The frequency with which the udders of tuberculous cows are 
affected is difficult to determine, as is very nicely shown by the obser- 
vations of the experiment station. For a period of about ten years 
only 1 per cent of the tuberculous cattle examined were found to 
have tuberculous udders ; while, on the other hand, among the tuber- 
culous cattle examined during the last three to four years fully 6 
per cent were found with tuberculous udders. The percentage given 
by Professor Moore is no doubt very near the truth. 

The number o c tubercle bacilli expelled from the mouths and noses 
of tuberculous cattle is probably not as great as the number expelled 
under parallel conditions of disease from the mouths and noses of 
tuberculous persons, because cattle cough less frequently and less vio- 
lently and do not spit. The tubercle bacilli that are expelled with 
the feces per rectum have their origin in the lung more commonly 
than elsewhere. They are raised into the mouth and swallowed and 
on their way through the intestinal tract become evenly mixed with 
the material that is ejected as feces from the bowels. The result is 

° Bureau of Animal Industry Bulletin No. 99. 

6 Cornell University, Bulletin 250, January, 1908. 



534 

that the large amount of feces passed by cows, about 30 pounds per 
day by a cow of average size, introduces an enormous amount of infec- 
tious material into their environment when they are affected with 
tuberculosis, much more than can be safely and economically dis- 
posed of so as to make this environment a proper place for the 
exposure of human food. 

As the discovery of virulent tubercle bacilli in the feces of tubercu- 
lous cattle is of comparatively recent date, and as some harmless 
bacilli closely resembling tubercle bacilli in appearance are of com- 
mon occurrence in and about stables and are supposed to be of com- 
mon occurrence in the feces of cattle, it is desirable to outline briefly 
the evidence on which the occurrence of virulent tubercle bacilli in 
the feces of tuberculous cattle rests. 

First. The microscopic examinations of the feces of a cow that was 
being fed small amounts of tubercle bacilli, in the form of cultures 
added to her drinking water, revealed germs precisely like tubercle 
bacilli. The cultures of tubercle bacilli fed to the cow were of a 
virulence too low to cause tuberculosis in cattle. The test of the 
bacilli in the feces showed that they were virulent for guinea pigs. 
This experiment proved that tubercle bacilli can pass through the 
entire length of a cow's intestinal tract and out with her feces without 
losing their pathogenic virulence. 

Second. Numerous microscopic examinations made with the feces 
of tuberculous cows and with the feces of healthy cows, stabled, fed, 
and generally kept under precisely the same conditions, revealed that 
the feces of the tuberculous cows contained bacilli like tubercle germs, 
and that the feces of the healthy cows did not contain such bacilli. 
With the exception of a few cases, the tubercle bacilli were not a con- 
stant factor in the feces of the tuberculous cows; their occurrence 
varied from cases in which they were found with every examination 
to cases in which they were found with daity examinations only once 
every two to three weeks. This intermittent character of the expul- 
sion of tubercle bacilli in the feces is precisely what should be ex- 
pected, when we bear in mind that the bacilli have their origin in 
the lung; that tuberculosis in the lungs of cattle, because of the 
abundant interlobular connective tissue, is not accompanied by free 
cavity formation, and that cattle do not cough as freely or as vio- 
lently as persons affected with lung tuberculosis. 

Third. Guinea pigs inoculated with small masses of fresh feces 
from tuberculous cows that were passing bacilli like tubercle germs 
per rectum became affected with typical, generalized, fatal tuber- 
culosis. 

Fourth. Cultures made from the bodies of guinea pigs that suc- 
cumbed to tuberculosis induced by the inoculation of fresh feces 
from tuberculous cows were found to be pure cultures of tubercle 











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24. SECTIONS OF THE TUBERCULOUS UDDER AND PUBIC LYMPH GLAND OF THE COW 
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Bull. 56, Hygienic Laboratory. 




26. SECTIONS OF THE UDDER AND PUBIC LYMPH GLAND OF THE 
COW SHOWN IN ILLUSTRATION NO. 25. 

The numbers denote, 1, longitudinal section of udder; 2, transverse 
section of udder; and 3, section of pubic lymph gland. The udder 
is affected with a diffuse, very acute tuberculosis. The lymph gland 
is many times its normal size, and though it shows no well-marked 
tuberculous lesions, fluid expressed from it was found on microscopic 
examination to be loaded with tubercle bacilli. 



535 

bacilli, and such pure cultures were proven to be virulent for cattle. 
In one instance, a cow inoculated subcutaneously with a culture of 
this kind became affected with rapidly progressive, generalized tuber- 
culosis, which terminated in death after a few months. 

Fifth. Hogs fed with the feces of tuberculous cows contracted 
typical tuberculosis. The feces were collected under conditions which 
insure that no infectious material was introduced into them that did 
not pass from the bowels of the cows. 

The expulsion of tubercle bacilli by cattle per rectum with their 
feces is one of the most important causes of tuberculosis among hogs, 
as we may judge from the following illustration, which represents a 
common farm scene — a herd of hogs in a hog yard adjacent to a cow 
stable. The cow stable contains a herd of tuberculous cattle ; the cat- 
tle are not permitted to enter the hog yard and the hogs are not per- 
mitted to enter the cow stable or the field in which the cows pasture. 
More than half the hogs that remain in the hog yard and root in the 
manure pile contract tuberculosis within six months. 

The relative frequency with which tuberculous cows expel tubercle 
bacilli per rectum has not been accurately determined. Among 12 
cows, collected from several dairy herds for use in an investigation 
in which a number of apparently healthy tuberculous cows were 
required, five, or 41f per cent, were found to be passing tubercle 
bacilli, intermittently, per rectum with their feces. Eighteen months 
later the number had increased to ten, or 83J per cent ; that is, it had 
doubled, though the majority of the cows still retained their ap- 
parently good condition and showed no marked symptoms of tuber- 
culosis. The feces of only a small number of cows that had been 
affected with tuberculosis three years or more have been examined; 
they were all found to be passing tubercle bacilli per rectum. 

THE APPEARANCE OE CATTLE THAT EXPEL TUBERCLE BACILLI. 

When we think of animals afflicted with diseases we usually picture 
them to our minds as showing distinct variations in their appearance 
and demeanor from what we regard as healthy and normal. Disease 
and no sj^mptoms is almost a contradiction, and this seeming contra- 
diction and truly paradoxical condition is one of the important facts 
about tuberculous cattle. 

As no description can define the appearance of an animal as well 
as a photograph, the following illustrations, Nos. 17 to 26, inclusive, 
made from photographs, are presented to show the frequently ex- 
cellent, seemingly healthy condition of dangerously tuberculous cat- 
tle. It must be added that the cattle represented in the pictures do 
not cough ; they have excellent appetites and no visible and no audible 
respiratory difficulties; in all respects they act like healthy animals 



536 

and perfect harmony exists between their healthy appearance and 
their healthy conduct. It is only when the tuberculin test is applied 
to them that their tuberculous condition is revealed, and it is only 
when the substances that are eliminated from their bodies, feces, 
saliva, milk, etc., are subjected to microscopic and other tests that 
the proof is obtained of their dangerous character for public health 
and for the health of other animals. 

Cattle like those shown in the illustrations supply the best proof we 
can obtain of the possibly dangerous character of dairy cows that are 
not specially proven to be free from tuberculosis by a careful applica- 
tion of the tuberculin test. These cattle are in excellent condition. 
Most of them are in better bodily condition than can be expected of 
ideal dairy cows that give large quantities of milk. They show no 
symptoms of disease and act precisely like normal, healthy animals. 
A cow like the subject of illustration No. 23 shows that cows with 
tuberculous udders may remain undetected until the tuberculin test is 
applied to them, and a cow like the subject of illustration No. 25 
proves conclusively that apparently healtlry tuberculous cows may, at 
any time, without previous warning, suffer an acute extension of the 
disease with which they are affected to their udders, through which 
their milk becomes so badly infected with tubercle bacilli that its use 
in a raw state would be suicidal. 

We may conclude that the general appearance of tuberculous cat- 
tle, until the disease is near its last stages, or has become generalized, 
or has dangerously encroached on vitall} 7 important organs, is like 
that of healthy cattle, and that the visibly good or bad condition of 
cattle is more a question of sufficient feed than of tuberculosis in its 
earlier stages. 

There was a time when veterinarians believed themselves competent 
to diagnose pulmonary tuberculosis of cattle in its earlier stages by 
physical examination, but most veterinarians, more particularly those 
who have had large experience in the examination of bovine lungs by 
means of ausculation and percussion, are now convinced that this is 
rarely possible. The broad, flat ribs, the thick hairy hide over the 
thorax, the transmission of sounds from the intestinal tract, which is 
enormously large because of the coarse materials ruminants eat, and 
the common location of tuberculous disease in the dorsal portion of 
the lung and in the mediastinal space, where it can not be detected at 
all from without, are a few of the conditions in cattle that interfere 
with the satisfactory application of the means of diagnosis that are 
of high value when they are applied to the more tractable and much 
smaller bodies of persons. 

In looking over the pictures given in this article it is desirable that 
the reader should bear in mind that no special effort was made to ob- 
tain photographs from many different sources so as to present ex- 




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537 

eeptional conditions. All the photographs are those of animals that 
were among a total of about 50 tuberculous cattle received at the ex- 
periment station during the last three years, and among this total of 
50 there were at least 25 animals that could well have been used to 
illustrate the excellent physical condition of dangerously tuberculous 
cattle and about 40 that could have been used to illustrate simply the 
healthy, normal appearance of tuberculous cows. 

As all persons are not acquainted with the miserable appearance of 
the cows from which a large part of the public milk supply is de- 
rived, and as it will serve as a means to emphasize by comparison the 
frequently excellent condition of seemingly healthy but, in fact, dan- 
gerously tuberculous cattle, two pictures are presented which show by 
no means the thinnest and most objectionable kind of cows actually 
found in dairy herds. 

HOW TUBERCLE BACILLI EXPELLED BY TUBERCULOUS COWS GET 
INTO MILK AND DAIRY PRODUCTS. 

It has been shown that seemingly healthy, tuberculous cows expel 
tubercle bacilli directly with their milk and at one end of their bodies 
with saliva and particles of food and at the other end with feces. 
Consequently, we may justly conclude, if it can be shown that the 
material discharged by cattle per mouth and per rectum occurs fre- 
quently as a contaminating element in commercial milk, that the milk 
of tuberculous cows, and also of healthy cows that are stabled and 
milked together with tuberculous cows, will often be infected with 
tubercle bacilli. 

In one of the publications of the United States Public Health and 
Marine-Hospital Service the following statement is made about the 
milk of Washington, D. C, which is no worse than that of other cities : 

In addition to being warm, much of the milk is dirty. Fifty-one of 172 
samples examined showed no visible deposit in the original container after 
standing several hours. Fifteen of the samples contained a very small amount 
of dirt, 98 contained a small amount of dirt, 8 contained much dirt, and 1 
contained (mouse?) feces. 

The foreign matter (dirt) when examined under the microscope was found to 
consist of fecal matter, hairs, epithelial and other cells, straw, bacteria, and all 
manner of extraneous substances that have no place in clean milk. a 

After several hours' standing in the original containers, 121 of 172 
samples, or TO per cent, of the kind of milk that reaches the consumer 
showed a visible deposit of dirt, which was found on microscopic 
examination to be made up in part of fecal matter, or that matter in 
which tuberculous cows most commonly expel tubercle bacilli. 

At the experiment station of the United States Bureau of Animal 
Industry a large number of samples of milk, purchased from regular 

a Hygienic Laboratory Bulletin 35, p. 71. 



538 

city milk dealers under ordinary market conditions, were placed in 
the tubes of a small centrifuge and rotated fifteen minutes at the rate 
of 2,000 revolutions per minute. Every sample treated in this way 
deposited a sediment, and microscopic examinations of the sediment 
revealed that 98 per cent contained particles of vegetable matter 
identical in appearance with minute fragments of bovine feces. 

On its face this is a very disgusting condition, but it is unfortu- 
nately even more dangerous than its superficial appearance indicates, 
as the solid impurities that reach the consumer in milk are only a frac- 
tion of the total solid impurities with which it has been in contact. 
Larger masses of feces and other larger, solid impurities that drop 
into milk or are splashed, sprayed, or otherwise introduced into it 
from the environment of cows are removed by the straining to which 
it is subjected before it is poured into the containers in which it is 
sold ; hence only those solid impurities that are small enough to pass 
through the strainer are found when samples of market milk are 
examined. 

What this means relative to the infection of milk with tubercle 
bacilli when it is obtained from or in the environment of tuberculous 
cows is a subject on which it is hardly necessary to enlarge. No firm 
union exists between the tubercle bacilli and the feces, throughout the 
entire mass of which they are evenly disseminated. The bacilli are 
present in an easily detached condition ; they are probably washed 
free from the feces that finds its way into milk, and they are too small 
to be removed by the strainer. In a test made regarding this matter 
it was found when guinea pigs were inoculated with normal, fresh 
milk to which small amounts of fresh feces from tuberculous cows had 
been added, amounts no greater than commonly fall into the milk pail 
during ordinary milking, that those inoculated after the milk had 
been strained succumbed to tuberculosis as rapidly as those inoculated 
with the milk before it was strained. 

That the solid material found in milk as sediment can not be taken 
as a true measure of the amount of solid, foreign, contaminating 
material with which it has actually been in contact is shown by the 
following observation. Among the samples of milk examined rela- 
tive to fecal content a number were found, with little or no vegetable 
sediment, that yielded cream in the tubes of a centrifuge discolored 
precisely like the cream obtained from milk to which uncommonly 
large quantities of cow feces were intentionally added. Such milk, 
because of its freedom from sediment and its discolored cream, must 
be regarded as very dirty and very dangerous milk that has been 
exceptionally well strained. 

The specific gravity of tubercle bacilli is higher than that of milk, 
and hence it does not seem unreasonable to suppose that they can be 
removed from it by sedimentation. This supposition would be true 



539 

if milk was a homogenous liquid like water and not an emulsion. In- 
vestigations made to determine how tubercle bacilli distribute them- 
selves in milk under different conditions proved that they adhere to 
the cream globules with a tenacity that can not be broken by a simple 
difference of specific gravity, even when this difference is reenforced 
by centrifugalization. The result is, when milk is allowed to stand 
for cream to rise, or when cream is separated from it rapidly in a 
centrifuge, the tubercle bacilli, when they are present, rise as abun- 
dantly with the cream globules as they gravitate with the sediment 
and disappear from the intermediate layer or the skim milk, which 
is practically a homogenous fluid. This holds true when pure cul- 
tures of tubercle bacilli are added to milk and also when the bacilli 
are introduced into it with tuberculous bovine feces, or with pus from 
tuberculous abscesses, and when they are present because of tuber- 
culous lesions in the udder of the cow from which it was obtained. 

These facts almost make it unnecessary to formulate the conclu- 
sion that cream, obtained from tuberculous milk, measure for meas- 
ure, contains more tubercle bacilli than the milk. 

Cream is the material from which butter is made, and that butter 
made from infected cream has the infection transferred to it was 
proven by repeatedly making butter from infected cream and test- 
ing it. 

It has been recorded that both strained and unstrained milk to 
which small masses of feces from cows affected with tuberculosis 
were added caused tuberculosis in guinea pigs. Cream from such 
strained and unstrained milk also caused tuberculosis in guinea pigs, 
and butter made from the cream of such strained and unstrained milk 
likewise caused tuberculosis in guinea pigs. 

Visibly affected tuberculous cows and cows affected with udder 
tuberculosis are no doubt a serious menace to public health when 
their milk is used raw in one form or another as human food, but, as 
dairymen are not exceptionally unscrupulous persons and will rarely 
sell milk from a visibly diseased cow, and as udder tuberculosis 
among cows that are not otherwise visibly diseased is rare, we may 
conclude that the apparently healtlry, tuberculous cow, the cow that 
intermittently expels tubercle bacilli from her body per rectum with 
her feces, is the most important tuberculous danger for public health 
that has its origin in the dairy herd. Such apparently harmless, 
actually dangerous cows not only infect their own milk, but also the 
milk of the other cows stabled with them, and, as we have seen, such 
infected milk, both strained and unstrained, equally when it is used 
as a beverage or as cream or as butter contains live virulent tubercle 
bacilli. 



540 

THE VIBAJLENCE AfrD VITALITY OF TUBEBCLE BACILLI Iff BAI1l¥ 

PRODUCTS. 

Less than ten years ago tubercle bacilli were grouped for all 
practical purposes in two classes, mammalian and avian, or those 
which affect man and other mammals and those which affect birds. 
No one doubted openly that bacilli from cattle, in meat and dairy 
products, were as injurious for man as those derived from persons. 
Pulmonary tuberculosis, or consumption of the lungs, was then, as 
now, the commonest form in which the disease manifested itself, 
and this was explained by the assumption that the bacilli entered the 
body more frequently with the breath than in any other way, and 
that the greatest danger of infection was through dried and pulver- 
ized tuberculous material that floated in the air as fine dust. 

The beginning of the present century brought a change of views. 
Attention was called to the fact that the inhalation theory to ac- 
count for the frequent presence of tuberculosis in the pulmonary 
tissues had not been proven and that living tubercle bacilli in dust 
were difficult to find or could not be found at all. The infectious- 
ness of bacilli from animals for man was questioned and the inves- 
tigation of tuberculosis generally was given a fresh impetus through 
which many new facts and theories came to light. 

As tubercle bacilli in dairy products are mainly derived from 
bovine sources and enter the body in a moist state, to understand 
the true significance they have for public health we must give some 
attention to the infectiousness of tubercle bacilli from bovine sources 
for man and to the ways in which tubercle bacilli enter the bodies 
of those who become affected with tuberculosis. 

Since Theobald Smith a published his studies on different varieties 
of tubercle bacilli, the evidence in favor of two distinct types virulent 
for mammals — the one found more commonly in bovine and the 
other in human lesions — has grown stronger. But different varieties 
or types do not necessarily mean different species or even subspecies. 
As Smith himself stated, " Varieties have been found among nearly 
all of those specific forms of pathogenic bacteria which have received 
a considerable amount of attention." & The term " varieties " is 
here clearly used to designate differences of a kind to be expected 
among the individuals of a large and widespread species, such differ- 
ences as we know occur among higher organisms than bacteria with 
a wide geographic distribution. There is a distinct parallelism be- 
tween a wide geographic distribution of higher plants and animals 

° Twelfth and Thirteenth Annual Reports, Bureau of Animal Industry, 1895 
and 1896. Jour, of Experimental Medicine, vol. 3, New York, 1898. 

6 Twelfth and Thirteenth Annual Reports, Bureau of Animal Industry, 1895 
and 1896, p. 149. 



541 

and the number and kinds of hosts a pathogenic bacterium may 
infect ; hence, there is no reason why the tubercle bacillus, which has 
received more attention and which affects more species of animals 
and more individuals than any other bacterium, should not have been 
found to include many different types, the extremes of which would 
leave us in doubt as to their specific classification if they were not 
connected by a chain of transition forms. 

Mohler and Washburn, a after a comparison of many tubercle bacilli 
from different sources and a careful search of the literature, con- 
cluded that the more the subject is studied the more numerous the 
instances become in which bacilli of special types are found occurring 
naturally in animals far removed from the species which may be 
supposed to be their natural host. They obtained cultures of tubercle 
bacilli from human lesions that were morphologically and biologic- 
ally bovine types, and in their summary of the investigations of 
others show that bovine types have frequently been obtained from 
man and human t}^pes from cattle. These investigators, 6 after a 
prolonged study of the susceptibility of tubercle bacilli to modifica- 
tion, draw the conclusion " that the morphology of tubercle bacilli 
is their most variable characteristic." They successfully changed the 
morphology and also the virulence of tubercle bacilli in the course 
of their investigations and found it possible both to reduce and in- 
crease the virulence of tubercle bacilli for different species of animals. 

As examples of changes in morphology, the following are instruct- 
ive as well as interesting: A tubercle culture isolated from sputum 
was given a more perfect so-called " human " morphological charac- 
ter than it originally possessed by passing it through cats. The same 
culture was given a perfect so-called " bovine " morphological char- 
acter by passing it through cattle. A culture isolated from a tuber- 
culous boy was found to be morphologically a bovine type; after 
fifteen generations on artificial media it was still bovine in character; 
by passage through cats it became, morphologically, a human type. 
A culture isolated from bovine tuberculous lesions was found to be 
morphologically a bovine type; it became morphologically a human 
type by growth on solidified human blood serum. It is reasonable to 
assume if human blood serum can effect this change in a morpho- 
logically bovine tubercle bacillus from a bovine source that the 
residence of tubercle bacilli from bovine lesions in the human body 
may likewise cause a change from so-called " bovine " to so-called 
" human " morphology. 

Mohler and Washburn are not the only investigators who have ob- 
tained results to prove that tubercle bacilli may be made to vary in 

a Bureau of Animal Industry Bulletin 96. 

6 Annual Report, Bureau of Animal Industry, 1906, pp. 113-163. - 



542 

morphology and virulence. In their work they give a history of in- 
vestigations similar to their own which strengthens the evidence for 
the conclusion that we can find nothing in the morphology and viru- 
lence of tubercle bacilli to encourage us to undervalue the importance 
of those from bovine sources for public health. 

Fibiger and Jensen,* who likewise obtained typical bovine bacilli, 
virulent for cattle, from human lesions, recall that the imperial Ger- 
man health office examined 39 cases of primary tuberculosis of the 
human intestines and mesenteric glands and found that 13 among 
them were caused by bacilli of the bovine type. Later investigations 
made by Fibiger and Jensen are summed up as follows : Though bo- 
vine types of tubercle bacilli are more commonly isolated from bovine 
lesions and human types from human lesions, there are cultures that 
must be considered as transition forms, as they have some of the 
characteristics of bovine and others of the human type. & 

Gorter, c after a careful study of tubercle bacilli from human and 
bovine lesions, found 7 among 21 cultures from human sputum which 
he regards as identical with the transition forms between human and 
bovine bacilli which he says are described by Rabinowitsch. He con- 
cludes that human and bovine bacilli are not different varieties, and 
that the conversion of the one type into the other actually occurs. 

Sargo and Suess d showed that mutations occur in human tubercle 
bacilli and other types, which speak against grouping tubercle bacilli 
from animals of different species as special varieties. 

Von Behring, 6 who ranks as one of the most widely recognized 
authorities on tuberculosis, found cultures of tubercle bacilli isolated 
from man of low virulence for cattle, and others of higher virulence 
for them than many cultures of bovine origin. He declares himself 
as opposed to the view that bovine tubercle bacilli may be harmless 
for man, and calls attention to the fact that they generally have a 
higher grade of virulence than human bacilli, and are therefore to be 
regarded as more dangerous. 

The British royal commission on human and animal tuberculosis f 
concluded from its investigations that cow's milk containing bovine 
tubercle bacilli is clearly a cause of tuberculosis, and of fatal tuber- 
culosis in man, and that a very large portion of tuberculosis con- 
tracted by ingestion is due to tubercle bacilli of bovine origin. 

a Berliner Klinische Wochenschrift, Nos. 4 and 5, 1907. 

6 Presented at the joint session of Sections I and VII of the International 
Congress on Tuberculosis, Washington, D. C, 1908. 

c Zeitschrift fur Tuberkulose, Vol. XI, No. 3, 1907. Also Inter. Centralb. fur 
die ges. Tuber. Fors., Vol. II, No. 1, 1907. 

d Centralb. fur Bacteriologie, etc., Vol. XLIII, Part I, pp. 422-529. 

e Berliner Tierarz. Wochens., No. 47, 1902. 

f Jour. Royal Institute of Public Health, Vol. XV, No. 3, 1907. 



543 

The nearly unanimous opinion of the members of the recent Inter- 
national Congress on Tuberculosis at Washington, D. C, was that 
the tuberculous dairy cow is a serious menace to public health. 

It does not seem necessary to add, as could easily be done, to this 
evidence to prove that the various existing types of tubercle bacilli 
are simply mutation forms of one specific organism. The presence of 
transition forms between human and bovine types ; the occurrence of 
pure bovine types in human lesions and of human types in bovine 
lesions; the occurrence of bacilli highly virulent for cattle in human 
lesions ; the generally greater virulence of bovine types for all species 
of animals ; and the virulence, and greater virulence, of bovine types 
for anthropoid apes and monkeys," or the animals in the zoological 
scale most nearly related to man, are all facts that support the conclu- 
sion that tubercle bacilli in dairy products are a source of great 
danger to public health. 

It is true that tuberculosis is more commonly an affection of the 
lung than of other portions of the body. The explanation for this, 
which was long regarded as satisfactory and is still accepted by many,' 
rests on the assumption that the most important source of tubercu- 
lous infection is finely pulverized, tuberculous material, suspended in 
the air as dust, and the direct exposure of the lung to this dust 
through the process of respiration. If this so-called "inhalation" 
theory is true, and as many of those who maintain it assert, tubercle 
bacilli can not pass through the uninjured wall of the digestive tract 
and reach organs remote to it without leaving evidences of their 
passage, then tubercle bacilli in dairy products have no important 
significance for public health. Therefore to prove that tubercle 
bacilli in dairy products are dangerous we must give some thought to 
the mode of infection, or the portal through which the bacilli enter 
the body. 

How strongly the inhalation theory was intrenched in the minds of 
medical men is well expressed by Aufrecht 6 in the statement that 
considerable courage was required only a few years ago to character- 
ize it as an unwarranted hypothesis for the wide belief of which no 
satisfactory evidence had been supplied. He, in 1900, and Baungar- 
ten, c in 1901, pointed out that it had not been proven to be the exclu- 
sive or even the most important mode of infection with tuberculosis. 
In 1902 followed the experiments of Nicolas and Descos,^ confirmed 
by those of Eavenel ' in 1903, which proved that tubercle bacilli 

a Report of the British royal commission in the British Journal, No. 2430, 
1907 ; also, Bureau of Animal Industry Bulletin No. 52, 1905. 
6 Berliner Klinisch Wochens., No. 27, 1907. 
c Wiener Med. Wochens., Vol. 51, No. 44. 
d Jour. Phys. et de Path. Gen., Vol. IV, 1902. 
e Jour. Med. Resea,, Vol. X, pp. 460-462. 



544 

introduced into the healthy intestinal canal of animals rapidly passed 
through the uninjured mucosa and appeared in the great thoracic 
duct on their way to the venous circulation. Nocard and his pupils, 
Desoubry and Porcher, a had earlier shown that the passage of bac- 
teria through the normal intestinal wall and their transference to the 
blood was possible. Chavreau, 6 in view of the constantly accumulat- 
ing evidence that pulmonary tuberculosis in man and animals arises 
from infection through the intestine, calls attention to his investiga- 
tions from 1868 to 1874, in which pulmonary tuberculosis was brought 
about by the ingestion of tuberculous material without the production 
of pathological conditions in the digestive tract. 

This earlier work was followed rapidly by other investigations, 
which proved more and more conclusively that the introduction of 
tubercle bacilli into the body with food may lead directly to the 
development of pulmonary tuberculosis, without lesions in the ali- 
mentary canal and without intermediate lesions of disease between 
the digestive and respiratory organs. The most important investiga- 
tions are probably those of Calmette and his associates, now pub- 
lished in book form. 

These investigators claim, and present good evidence in support of 
their claim, that dust particles never penetrate deeper into the lung 
than to the first banches of the bronchi ; that tuberculosis is constantly 
a disease of which the infection enters through the intestine;, that 
tubercle bacilli may penetrate the intestinal wall without causing 
lesions; that the bacilli may pass through the mesenteric glands with- 
out causing lesions ; that the bacilli frequently cause primary lesions 
in the mesenteric glands of young experiment animals, but commonly 
pass through these glands of adult animals and cause primary pul- 
monary tuberculosis; that tuberculous processes in the lung never 
begin in the bronchi or alveoli, but constantly in the capillaries, 
especially in the finest capillary network of the subpleural tissue, etc. 

Eelative to this localization of the earliest stages of pulmonary 
tuberculosis, Auf recht d says : 

The initial changes in the apices of the lung, as I have convinced myself by 
repeated anatomical examinations, do not spread from the terminal branches 
of the bronchi. 

a Comp. Rend. Soc. de Biologie, Vol. XLVII, 1895. 

6 Experiment Station Record, U. S. Dept. of Agriculture, Vol. XIX, No. 2, 
1907. (Comp. Rend. Acad. Sci., No. 15, Paris, 1907.) 

c Recherches experimentales sur la Tuberculose, effectuees de l'institut Pas- 
teur de Lille, par Calmette et Guerin, P. Vansteenberghe, M. Breton, Grysez, 
Sonneville et Georges Petit, Paris, 1907. Reviewed in the monthly publication 
of the International Antituberculosis Association, Tuberculosis, Vol. VI, No. 5, 
1907, pp. 256-259 ; also in Zeitschrift fiir Tuberkulose, Vol. XI, No. 2, 1907, pp. 
163-166. 

d Berliner Klinische Wochens., No. 27, 1907. 



545 

He further says that he has — 

proven the cheesy tubercle in the lung to be associated not with the finer 
branches of the air tubes, but with the terminal capillaries of the pulmonary 
arteries. 

While he is not a special advocate of the intestinal way as the sole 
mode of infection, he ends his article here referred to with these 
words : " The inhalation theory for lung tuberculosis is no longer 
tenable." Kohler, a who reviews Aufrecht's work, justly remarks that 
it deserves wide recognition, as it supplies important arguments for 
a thorough revision of the older views about the development of 
pulmonary tuberculosis. 

Fibiger and Jensen h conclude from their own investigations and 
a critical analysis of the reports from numerous widely separated 
hospitals that the former doctrine, which taught that primary intes- 
tinal tuberculosis is a rare disease, can no longer be held as valid. 
Among 289 children from 1 to 15 years old who had succumbed to 
various diseases, 44, or over 15 per cent, were found on autopsy to be 
affected with primary intestinal tuberculosis. These investigators 
say that we must, without doubt, return to our former view and re- 
gard the ingestion of raw milk as an important cause of primary 
intestinal tuberculosis during childhood. This view is in perfect 
harmony with Calmette's experiments, which proved that primary 
intestinal tuberculosis is of commoner occurrence, with infection that 
enters the body through the alimentary canal, in youth than in adult 
life, because tubercle bacilli can pass through the mesenteric glands 
of adults more readily than through those of children. 

Orth c makes the statement that even with localized tuberculosis 
in the lymph glands and the lung we can not exclude the intestine as 
the portal of entry for the tubercle bacillus. At the international 
conference on tuberculosis, held in Vienna during September, 1907, he 
said that tubercle bacilli can enter the body from the intestinal canal, 
which might itself, however, remain completely unaffected, but that 
from the prophylactic point of view the channel of infection was of 
only secondary importance, as the object to be aimed at was the de- 
struction of all sources from which infection might take place. As 
sources of infection be named milk and butter from tuberculous cows 
and sputum from tuberculous individuals, and bovine tuberculosis 
he characterized as undoubtedly infectious for human beings.** 

Klebs e has convinced himself that tuberculosis is a disease of the 
lymphatic system and may remain such until the end of life, and that 

°Intren. Centralb. fur die gesam. Tuber. Forsch., Vol. II, No 1, 1907. 

6 Berliner Klinische Wochens., Nos. 4 and 5, 1907. 

c Berliner Klinische Wochens., No. 8, 1907. 

d Editorial in the New York Medical Record, vol. 72, No. 22, p. 905, 1907. 

e Deutsch. Medic. Wochens., No. 15, 1907. 

45276°— Bull. 56—12 35 



546 

infection occurs through the intestines, most frequently with bacilli 
contained in cow's milk. He claims to have established this as a 
fact with experiments made at Berne, and published in Virchow's 
Archives in the early seventies of last century. He says that he has 
found no reason to change his views, and calls attention to the con- 
clusive manner in which they have been proven by the unimpeachable 
experiments of Orth, Von Behring, and Calmette. 

Gorter a adds his testimony to show that the intestinal mode of in- 
fection is not rare, and Bongert & showed with rats, as was shown by 
the experiment station of the Bureau of Animal Industry c with hogs 
and cattle, that the injection of pure cultures of tubercle bacilli into 
portions of the body as remote as possible to the thorax caused pul- 
monary tuberculosis without intermediate lesions to connect the loca- 
tion of the disease in the lung with the portal at which the infecting 
bacilli were introduced. 

Baumgarten^ concluded after experimental studies and a review 
of the literature that for practical, prophylactic purposes we must 
consider not only the inhalation theory and ingestion as modes of 
infection, but all possible ways in which tubercle bacilli may enter 
the body. 

It is not intended to give a complete summary of all the investi- 
gations that have supplied evidence to support the fact that tubercle 
bacilli can and do penetrate the wall of the digestive tract without 
affecting it and pass to the lung and there cause lesions. It has been 
amply shown that the intestinal mode of infection for pulmonary and 
other forms of tuberculosis, unlike the inhalation of tubercle bacilli 
directly into the lung tissue, is not merely a theory, but a well-estab- 
lished truth, which has forced its way to recognition in the face of 
considerable opposition. Hence, the frequency with which tubercu- 
losis is a pulmonary disease can not be used as an argument to en- 
courage an undervaluation of tubercle bacilli in dairy products; on 
the contrary, the mode of infection with tuberculosis, the certainty 
with which tubercle bacilli may enter one portion of the body and 
leave it unaffected and cause disease in other portions, condemns 
dairy products infected with tubercle bacilli as a serious menace to 
public health. 

The relative virulence of tubercle bacilli in moist, opaque sub- 
stances like milk, cream, butter, and cheese ; in dry dust from tuber- 
culous material; in translucent substances like sputum; and in 

° Zeitscnrif t fur Tuberkulose, Vol XI, No. 3, 1907; also Intern. Centralb. fur 
die ges. Tuber. Forscn., Vol. II, No. 1, 1907. 
6 Tierarz. Wochens., Vol. XV, No. 29, 1907. 
c Bureau of Animal Industry Bulletin 93, 1906. 
d Inter, Centralb, fur die ges. Tuber. Forscn., Vol. II, No. 1, 1907. 



547 

transparent substances like the infectious spray of droplets that 
escape from the mouths of tuberculous subjects during more or less 
violent expiratory efforts, also seems to emphasize that the tuberculous 
cow is a very important source of human tuberculosis. 

Cornet a is probably the strongest advocate of the dust-inhalation 
hypothesis. According to his views, dried, pulverized tuberculous 
sputum is the most important factor for the dissemination of tubercle 
bacilli and the transmission of tuberculosis from person to person, 
notwithstanding that he himself calls attention to the rapidity with 
which the bacilli die upon exposure to light and drying; to the 
difficulty with which a tough, sticky substance like sputum is pul- 
verized, and to the fact that only a small fraction of a mass of 
sputum can reach a sufficiently fine state of pulverization to float in 
the air, or that fine state which he believes necessary for its direct 
introduction into the finest branches of the bronchial tubes. 

Sunlight is the most potent, natural agent for the sterilization of 
tubercle bacilli; it kills them in less than one hour when they are 
exposed to its direct rays in translucent layers of infectious pus, and 
in less than five hours when they are exposed in thick, opaque masses 
of such pus. & Weinzirl c asserts that tubercle bacilli, as well as other 
nonsporulating pathogenic bacteria, are destroyed in from two to ten 
minutes by direct sunlight, and Koch,^ Jousett, e Fliigge/ Heymann, 9 ' 
Di Donna, 71 Cadeac/ and others earlier called attention to the rapidity 
with which tubercle bacilli are destroyed by desiccation and exposure 
to light. 

If light and drying are the potent factors for the destruction of 
tubercle bacilli the practical evidence shows them to be, it becomes 
questionable whether tuberculous sputum, which is so tough that it is 
difficult to pulverize in a mortar with a pestle after it has been 
thoroughly dried, ever reaches a state of pulverization in nature that 
will enable it to float in the air without first wholly losing its infec- 
tiousness. Of course, there are scores of ways in which moist tuber- 
culous sputum is dangerous, and hence the rapidity with which light 
destroys tubercle bacilli and the difficulty with which sputum is 
pulverized must not be taken as facts that justify or excuse careless 
spitting. 

a Die Tuberkulose, Vienna, 1907, pp. 101-117. 
b Bureau of Animal Industry Circular No. 127, pp. 17-20. 

c Dept. Agr. Expt. Sta. Rec, Vol. XIX, No. 3, p. 280, 1907. (Jour. Infect. 
Diseases, May, sup. 3, pp. 128-153.) 
d Cornet, Die Tuberkulose, p. 41. Vienna, 1907. 
e Wiener Med. Wochens, 1901, No. 28, p. 1366. 
f Zeitschrift fur Hygiene, vol. 38. 
9 Editorial Jour. Amer. Med. Asso., Oct. 12, 1901. 
h Centralb. fur Bact. und Parisitenk, Vol. XLII, No. 7. 
* Le Bulletin Medical, Sept, 5, 1906, 



548 

The vitality and virulence of tubercle bacilli in dairy products is 
very different from their rapid destruction in sputum, and we must 
also bear in mind that they are not on the floor, or in the air, or in 
other places from which they may or may not gain access to our 
bodies, but that they are contained within articles of food with which 
they will certainly be introduced into our bodies. 

Broers, a whose work on tuberculous dairy products is based on 
careful observations, found that tubercle bacilli will live three days in 
milk, even when it has undergone changes to make it unfit for use as 
food, twelve days in buttermilk, and that they certainly remain 
virulent in butter three weeks. As milk and buttermilk are rarely 
used in a raw state after they are more than three days old, it is not 
necessary to show that the tubercle bacilli they may contain will re- 
main alive and virulent longer than Broers has recorded. The length 
of time the bacilli remain virulent in butter is another matter, and 
regarding it the available data are very contradictory, as is shown by 
Cornet, & who says : 

Laser could find no live tubercle bacilli in butter after twelve days ; Heim 
records that all tubercle bacilli eventually die in butter, and that their maximum 
life in it is thirty days; Gasperini found a reduction of virulence after thirty 
days, though the bacilli were still alive after one hundred and twenty days ; and 
Dawson did not observe a reduction of virulence until after three months, and 
claims to have produced tuberculosis in a guinea pig by inoculating it with 
butter eight months old. 

As the two extremes, twelve days and eight months, are too far 
apart to be satisfactory, an investigation relative to this matter 
was undertaken at the experiment station of the Bureau of Animal 
Industry. 

Butter was made from the milk of a cow affected with udder 
tuberculosis, and tested from time to time by making guinea-pig 
inoculations with it. The butter was salted at the rate of 1 ounce of 
salt to the pound of butter, and the conclusions drawn regarding it 
are as follows.: 

The guinea-pig inoculations show that tubercle bacilli in ordinary salted 
butter undergo no attenuation in forty -nine days ; that they are still highly 
virulent after ninety-nine days, or more than three months, and that they are 
still alive after one hundred and thirty-three days. 

Since these tests were made it was found that the bacilli are still 
alive after one hundred and sixty days, which indicates that Daw- 
son's period of eight months is not an exaggeration. 

As the investigations of the experiment station regarding the long- 
retained virulence of tubercle bacilli in butter called out a popular 

a Zeitschrift fur Tuberkulose, Vol. X, No. 3. 

6 Die Tuberkulose, Vienna, 1907, p. 124. 

c Bureau of Animal Industry Circular No. 127. 



549 

criticism to the effect that the inoculation of guinea pigs was not a 
sufficient test to show that such bacilli are dangerous when they are 
ingested, the following experiment was made: 

Four hogs, weighing 125 pounds each, were tested with tuberculin 
to make sure that they were free from tuberculosis, and then placed 
in four separate disinfected pens. Each hog was fed 1 ounce of 
butter daily in addition to its other feed ; the butter was of the kind 
used for the guinea-pig-inoculation tests; the feeding was continued 
thirty days. This butter consisted of several different lots, the 
youngest of which was 90 days or 3 months old when it was fed to 
the hogs. The amount of butter received daily by each hog was less 
than the average person of the same weight eats, and the total amount 
received by each hog was less than 2 pounds. 

Several months after the feeding of butter was discontinued the 
hogs were killed and examined post mortem, and three of the four 
were found to have contracted tuberculosis. 

More direct evidence to prove that tuberculosis is contracted from 
infected food, and more direct evidence to prove that tubercle bacilli 
remain alive and virulent a quarter of a j^ear in ordinary butter, 
would be difficult to obtain. 

In oleomargarine tubercle bacilli may also remain alive long periods 
of time, probably as long as in butter^ which it closely resembles in 
general character. In cheese the germs are especially dangerous when 
they occur in fresh products, like cottage cheese, but that even those 
cheeses which require some time to ripen are not wholly safe is shown 
by the fact that Prof. F. C. Harrison proved that tubercle bacilli 
may remain alive in Cheddar cheese, a standard American variety, 
one hundred and four days. a 

We may conclude, as far as it is possible to test the vitality and 
virulence of tubercle bacilli from different sources and in different 
environments, that those from cattle are, as a rule, the most virulent, 
and that it seems to be clear that dairy products generally, and butter 
especially, supply an ideal medium for the preservation of both the 
life and virulence of tubercle bacilli. 

THE PROPORTION OP TUBERCULOUS COWS AMONG THOSE IN USE 
POR DAIRY PURPOSES. 

General statistics from which we can determine the percentage of 
dairy cows affected with tuberculosis are not obtainable. In the Dis- 
trict of Columbia about IT per cent of the cows tested with tuberculin 
reacted, and in the State of New York the figure among those tested 
is about 30 per cent. It does not absolutely follow from this that the 
cattle of New York State are more commonly tuberculous than those 

° United States Bureau of Animal Industry, Annual Report, 1902, p. 228. 



550 

of the District of Columbia, because in both places the number tested 
is only a small portion of the total number in use, and the percent- 
ages of tuberculosis obtained respectively may have been influenced 
largely by the motive that prompted the application of the test. 
When tests are made at the request of those who own dairy herds, it 
may be assumed that the owners of exceptionally good herds will be 
in the majority, and the percentage of tuberculosis discovered will 
be low. If, on the other hand, the tests are largely forced for the 
protection of public health because tuberculosis is suspected among 
the tested animals, the percentage of tuberculosis found will rise to 
the maximum figure. 

The writer has personally tested a large number of dairy herds 
in widely separated localities, and in all his tests did not have the 
good fortune to find a single herd entirely free from tuberculosis. 
Most of these herds, however, were tested at the request of owners 
who had some reason to suspect tuberculosis among their cattle, and 
hence this discouraging experience can not be used as a reason for 
assuming that few perfectly healthy dairy herds exist. 

From the figures and estimates that are available it seems fair 
to conclude that not less ,than 20 per cent of our dairy cows are 
tuberculous, and that tuberculosis occurs to some extent in about 
30 per cent of our dairy herds. These are believed to be conservative 
figures, but they must be taken strictly as having purely and simply 
the value of an estimate. In some European countries, where better 
statistics are available than in the United States, it is safe to con- 
clude that not less than 40 per cent of all dairy cows are tuberculous, 
and this high percentage will be reached among our dairy cattle 
before long unless vigorous means are used to prevent the further 
spread of tuberculosis among them. 

THE FREQUENCY WITH WHICH DAIRY PRODUCTS HAVE BEEN 
PROVEN TO CONTAIN TUBERCLE BACILLI. 

The truest test of the measure in which the public is exposed 
to tubercle bacilli from bovine sources is the frequency with which 
tubercle bacilli occur in dairy products. 

Without reviewing investigations of older date or those made 
in foreign countries, four comparatively recent investigations made 
in America show how common the occurrence of virulent tubercle 
bacilli in milk is. The largest of the four investigations showed 
that 15, or 6.7 per cent, of 223 samples of milk contained tubercle 
bacilli. The milk was obtained from 102 dairies, among which 11, 
or 10.7 per cent, were distributing infected milk. a The second 
investigation showed that 2, or 2.7 per cent, of 73 samples of milk 

a J. F. Anderson, United States Public Health and Marine- Hospital Service, 
Hygienic Laboratory Bulletin No. 41, pp. 163-192. 



551 

contained tubercle bacilli. a The third investigation showed that 2, 
or 5.5 per cent, of 36 samples of milk contained tubercle bacilli. 
The milk was obtained from 26 dairies, among which 2, or 7.7 per 
cent, were distributing infected milk. & The fourth investigation 
showed that 17, or 16 per cent, of 107 samples of milk contained 
tubercle bacilli, and that among 8 samples of commercially pasteur- 
ized milk one was found that contained live tubercle bacilli. 

The four investigations taken together show that among the 439 
samples of milk 36, or 8.2 per cent, were infected with live, virulent 
tubercle bacilli. 

The fact that one among eight commercially pasteurized samples of 
milk contained living tubercle bacilli is conclusive proof that some of 
the so-called " pasteurization," commercially practiced, is worse than 
useless, and has the evil tendency to quiet the mind regarding grave 
dangers it does not correct. 

It is a serious charge against the milk commonly sold by dairies to 
say that fully 1 sample among every 12 contains living, virulent 
tubercle bacilli, and yet this is the most favorable conclusion we can 
draw from four of the most recent and most reliable investigations 
with which the writer is acquainted. 

A further analysis of the two among the four milk investigations 
that give the number of dairies from which milk was tested proves 
that the conditions are worse than their superficial appearance indi- 
cates. These two investigations show that 17, or 6.5 per cent, of 259 
samples of milk obtained from 128 dairies were infected, and that the 
infected milk was sold by 13, or 10 per cent, of the dairies. The two 
investigations also show that the total number of samples of milk 
obtained from the 13 infected dairies is 31, of which 17 were infected 
and 14 were free from infection. Hence, the difference between the 
percentage of infected milk samples and the percentage of infected 
dairies can not be explained on the assumption that it is due to the 
more frequent duplication of tests with milk from the noninfected 
than from the infected dairies; it is shown on the face of the evidence 
that the difference of the two percentages is due to the fact that 
infected dairies distribute infected milk intermittently and not 
continuously. 

The intermittent distribution of infected milk by infected dairies is 
not only interesting because it may be related to the intermittent ex- 
pulsion of tubercle bacilli by cattle with their feces, but also because 
it justifies that we should draw the conclusion from the milk tests we 

a J. It. Mohler, same work as above, pp. 493-^95. 

6 Unpublished work of the experiment station of the United States Bureau of 
Animal Industry. 

c Dr. Alfred Hess, of New York. Paper presented at the International Con- 
gress on Tuberculosis, Washington, D. C, 1908. 



552 

have under consideration that a larger proportion of dairies than even 
10 per cent must be classed as infected. 

To obtain further information regarding the intermittent distribu- 
tion of tuberculous milk by infected dairies, samples of milk were 
bought from a dairy, from which several months previously a sample 
of milk had been obtained that was found to be infected with virulent 
tubercle bacilli, on 30 different days and injected into guinea pigs. 
Among the 30 samples the second, third, and eighth were found to 
contain tubercle bacilli ; the remaining 27 were not infected. If we 
add the sample of milk which first showed the infected character of 
the dairy to the 30 later samples, we have 31 from one source among 
which 4, or about 13 per cent, were found to contain tubercle bacilli. 
It does not require much reasoning to conclude from this evidence 
that the chances for discovering an infected dairy by testing one 
sample of milk from it may be equal to only 13 per cent, and the 
chances that the one test will not reveal the infected character of a 
dairy may be nearly eight times as great as the chances that it will. 

I do not wish to create an exaggerated idea of the proportion of 
dairies that intermittently distribute tubercle bacilli in milk, because 
the facts are so grave that, without exaggeration, they are almost be- 
yond belief. It is well, however, to know the truth, and through 
knowing it, to be convinced that the milk of no dairy can be accepted 
as permanently free from tubercle bacilli unless it is obtained in a 
clean, wholesome environment from cows shown by the application of 
the tuberculin test to be free from tuberculosis. 

The available data regarding the frequency with which tubercle 
bacilli occur in butter and other dairy products than milk are very 
meager for the United States, but when we know that tubercle bacilli 
in milk are transferred to the cream, butter, cheese, etc., made from 
it, we can readily infer how commonly these products are infected. 
Relative to the infection of cream and butter the following para- 
graph from a report of the United States Secretary of Agriculture 
is very significant : 6 

The examination of sediment taken from cream separators of public cream- 
eries throughout the country has demonstrated the presence of tubercle bacilli 
in about one-fourth of the samples. 

In a recent publication of the United States Bureau of Animal 
Industry it was pointed out that both the tendency of tubercle bacilli 
to rise with cream and a comparison of European statistics relative 
to the frequency with which tubercle bacilli have been detected, 
respectively, in milk and butter indicate that when tubercle bacilli 

Unpublished work of the experiment station of the United States Bureau of 
Animal Industry. 

6 Annual Report of the Secretary of Agriculture, Washington, D. C, 1907, 
p. 30. 



553 

are present in milk they will no doubt be present in greater concen- 
tration in cream and butter. a 

We can protect ourselves against the tubercle bacilli that are dis- 
tributed in milk by practicing home pasteurization ; but with butter 
this is not possible; and it is therefore desirable that the milk or 
cream used in the manufacture of butter should either be obtained 
from cows certainly free from tuberculosis, or that it should be 
pasteurized before it is used. 

SUMMARY. 

We have seen that tuberculosis is the commonest disease of both 
persons and dairy cows, and that persons and dairy cows are its com- 
monest victims; we know that dairy products are indispensable, and 
that they are more commonly eaten in a raw state than other products 
from animals ; we have seen that tuberculosis is an insidious, chronic 
disease, and that tuberculous cows often expel tubercle bacilli long- 
before they show signs of their diseased condition ; we have seen that 
milk is almost invariably contaminated with the material in which 
tuberculous cows most commonly expel tubercle bacilli from their 
bodies ; & we have seen that milk is so often infected with virulent 
tubercle bacilli that unless we know it to be derived from cows that 
are certainly free from tuberculosis it is not safe to use it in a raw 
state ; we have seen that tubercle bacilli in milk are transferred to the 
cream, butter, and cheese made from it, and may occur in these prod- 
ucts in greater concentration than they had in the milk from which 
they were derived ; we have seen that no better medium for the preser- 
vation of the life and virulence of tubercle bacilli can be found than 
the moist, bland, and opaque character of butter offers ; we have been 
told that the medical profession is well-nigh unanimous in the view 
that tubercle bacilli from the bovine source in dairy products are a 
serious menace to public health ; and we have seen that, in our fight 
for the suppression and eventual eradication of tuberculosis, we must 
seek to make harmless all the sources from which tubercle bacilli are 
expelled. Add to this that the available evidence regarding different 
types of tubercle bacilli shows that bovine types have been found in 
human lesions and human types in bovine lesions; that transition 
forms connect bovine types directly with human types ; that the most 
variable feature about a tubercle bacillus is the character that is used 
to classify it as a special type ; that tubercle bacilli of human types 
have been converted into bovine types and those of bovine types into 

° Bureau of Animal Industry Circular 127, 1908, pp. 4-5. 

6 The expulsion of virulent tubercle bacilli with the feces from the bodies of 
apparently healtlry, tuberculous cows has been confirmed since this article was 
written by the British Royal Commission on Human and Animal Tuberculosis. 
See Third Interim Report, London, 1909. 



554 

human types, and that tubercle bacilli of the so-called " bovine " type 
are, as a general rule, more virulent than those of the human type for 
all animals, including manlike apes, and the conclusion is almost 
forced upon us that the tuberculous dairy cow is, to say the very least, 
one of the most important sources of tubercle bacilli with which we 
have to deal. 

The commoner occurrence of tuberculosis in the lung than in other 
parts of the body should not encourage us to undervalue tubercle 
bacilli concealed in articles of food, as it has been shown that infection 
may penetrate to the lung as easily by the way of the intestine as 
directly through the trachea and bronchi ; in fact, a critical considera- 
tion of the two modes of infection, inhalation and ingestion, shows 
that the latter is in better harmony with known facts than the former. 

As there is a lack of clearness about the popular conception of the 
channels through which disease germs may penerate into and injure 
the lung, it may be well to devote a few additional paragraphs to 
this subject. 

The inhalation of infectious material directly into the lung re- 
quires, first, that the infectious material must be suspended in the 
air, and, second, that the infectious material must remain in suspen- 
sion while the air passes through a long, narrow, tortuous, moist- 
walled system of channels. We have seen how difficult it is to pul- 
verize the tuberculous material, sputum, from which fine tubercu- 
lous dust is supposed to arise, and we have seen how rapidly tubercle 
bacilli are destroyed when they are exposed to light and drying; 
hence we may conclude that dust charged with live, virulent tubercle 
bacilli is by no means plentiful. But even if tuberculous dust was 
abundantly suspended in the air, its penetration into the finer bron- 
chial tubes of the upper portions of the lung, where tuberculous proc- 
esses most commonly begin, would necessitate a suspension of the laws 
that govern the relative movements of substances of higher and lower 
specific gravity actuated by the same force. 

When a moving fluid holds solid particles of relatively higher 
specific gravity in suspension, every change in the direction of the 
movement will cause the heavier, solid particles to move somewhat 
more tangentially than the lighter fluid. If the movement occurs in 
a tube, the heavier particles will be thrown with more or less force 
against the wall of the tube. When the heavier particles are a dry 
dust and the fluid is a dry gas like air and the movement occurs in 
moist-walled channels like the air tubes, the dust will be thrown 
against and adhere to the moist walls, and the air will be thoroughly 
purified long before the number of turns or changes of direction have 
been made that occur in the air passages from the exterior of the 
body to the finer bronchial tubes. Now, the larger air tubes on 
which dust may be deposited are covered with a ciliated epithelium 



555 

or cells, which have fine hairlike processes that are in constant motion, 
and the motion is of a kind that tends to move dust, etc., outward 
and not farther into the lung. 

From this it should readily be seen that the inhalation theory to 
account for the infection of the lung is simple only when we fail to 
analyze it, and that analysis shows it to be a practically impossible 
hypothesis. 

The normal channel through which material from without enters 
the body is the digestive canal. It has been shown by Nicolas and 
Descos, Ravenel, Schloszmann and Engle, Calmette and his asso- 
ciates, and other bacteriologists and pathologists too numerous to 
mention, that tubercle bacilli may penetrate rapidly through the 
healthy walls of the intestines and reach the great thoracic lymph 
duct. The thoracic lymph duct empties its contents into one of the 
large veins that communicate with the heart; mixed with the blood 
in this vein the material from the duct enters the heart and is pumped 
directly to the lung, where it is filtered through the lung capillaries, 
which are the finest and most complex capillaries of the body. If we 
recall that the careful anatomical examinations made by Aufrecht 
and by Calmette and his associates proved that the tuberculous proc- 
esses in the lungs have their beginning in the finer capillaries and 
not in the finer air tubes, we are in a position to conclude that infected 
food much more than infected air is to be dreaded as a cause of 
tuberculosis. 

Tuberculosis among dairy cows is so common and wide spread that 
we can not hope to clean all dairy herds of the disease for some time 
to come; hence it is necessary for the protection of health to avail 
ourselves of the one expedient which is immediately at hand, and 
that is pasteurization ; and pasteurization should not be restricted to 
milk, but all milk, cream, etc., used in the manufacture of butter, 
cheese, and other dairy products, should be pasteurized, unless it is 
obtained from healthy, nontuberculous cows that are stabled under 
hygienic conditions in an environment wholly free from tuberculous 
infection. 

The elimination of tuberculosis from the dairy herd is urgently 
recommended, not only because the protection of public health re- 
quires it, but also because tuberculosis among cattle is a serious cause 
of pecuniary loss, so serious indeed, that, from the strictly economic 
point of view, it must be regarded as the most important problem 
those who are interested in animal husbandry can undertake to solve. 



16. SANITARY INSPECTION AND ITS BEARING ON 
CLEAN MILK. 



(557) 



SANITARY INSPECTION AND ITS BEARING ON CLEAN MILK. 



By Ed. H. Webster, 
Chief of Dairy Division, Bureau of Animal Industry, Department of Agriculture. 



In discussing this subject it will be assumed that the herd is in per- 
fect condition as regards health, that there are no persons employed 
in or about the dairy suffering from any communicable disease, and 
that the water supply has been examined and found pure. This 
assumption is made with the understanding that if any of these con- 
ditions are not complied with the milk will be debarred from the 
market, or under certain prescribed regulations be allowed sale after 
pasteurization. 

CLEAN MILK. 

It is evident that in nature's scheme for the nourishment of the 
young milk was never intended to see the light of day, and if suckled 
from a normal, healthy gland is the perfect food for the offspring. 
In this natural method of nourishment there is little possibility of 
contamination from outside sources. As soon as the artificial method 
of drawing milk is resorted to there enters a whole set of conditions 
entirely new and different. The milk then comes in contact with the 
air, the vessel into which it is drawn, and with particles of dirt from 
many sources. 

The problem of securing clean milk — i. e., milk as near as possible to 
the condition as it exists in the udder — is the problem of dairy sani- 
tation. To put it in another way, it is the problem of reducing con- 
tamination from all outside sources to the least possible factor. 

WHAT IS CONTAMINATION*. 

If the mere presence of solid particles of dirt so frequently found 
in the milk were the only damage wrought, the question would resolve 
itself into the simple operation of straining or passing the milk 
through a clarifier. The presence of solid dirt is, however, an indica- 
tion of much more serious conditions. Bacteriology teaches that 

(559) 



560 

every particle of dirt, whether it seems to the eye a source of con- 
tamination or not, carries with it great numbers of bacteria, and that 
milk at ordinary temperatures, 65° F. to 100° F., is an excellent 
medium for their growth, and most of the changes that take place 
in milk can be traced directly to such action. 

Neither straining nor clarifying will remove the bacteria from the 
milk, hence the necessity of keeping the dirt out, not straining it out. 

SOURCES OF CONTAMINATION. 

From the act of milking to the final consumption of the milk the 
possibilities of contamination are many and varied in character. 
Everything that comes in direct contact with the milk may be a 
source of trouble, and many things may act indirectly and seriously 
affect the results desired. 

MILKING. 

The first contamination usually begins with the act of milking. 
If the udder and flanks of the cow are covered with the dirt of the 
yard or stable the process of milking will dislodge a greater or less 
portion of this filth, causing it to fall into the pail. 

The amount of filth that may be on a cow will depend very much 
on the condition of the stable yard, and floor, gutter, and bedding 
in the stables. 

The following illustrations are used to better show conditions 
which are too common the country over. The condition of the cow 
shown in Fig. 29 is not exaggerated. The milker is probably all 
unconscious that he is sowing the seeds of contamination and destruc- 
tion, which may sooner or later cause the death of infants who are 
unfortunate enough to be fed from milk produced under such cir- 
cumstances. If he is aware of this fact he is criminal in purpose 
and intent, and the most stringent penalties should be provided to 
stop such work. Figs. 31, 32, 33, and 34 show exteriors and interiors 
of barns which will contribute to such a fearful condition. 

As to the amount of filth that will get into the milk and the result 
on the product, reports from the Illinois Experiment Station and 
Storrs ( Conn. ) Experiment Station are here quoted : 

The average weight of dirt which falls from muddy udders during milking 
is 90 times as great as that which falls from the same udders after washing, 
and when udders are slightly soiled it is 32 times as great. (Bulletin No. 84, 
Illinois Experiment Station.) 

Wiping the flank and udder of the cow with a damp cloth just before milk- 
ing is a very efficient method for reducing the number of bacteria which falls 
into the milk pail. (Stocking. — Bulletin No, 42, Storrs Experiment Station.) 







3 ^ 

P 



Bull. 56, Hygienic Laboratory. 



30. CLEANING COWS PREPARATORY TO MILKING. A SIMPLE OPERATION 
REQUIRING NO OTHER OUTLAY THAN A LITTLE TIME. 



Bull. 56, Hygienic Laboratory 




33. FILTHY WALLS, FLOORS, AND CEILINGS. A CONDITION FREQUENTLY MET WITH IN OLD 
BARNS. CEILING FULL OF COBWEBS AND DUST, WALLS AND FLOORS SHOW LITTLE EVI- 
DENCE OF CLEANING. CLEAN MILK CAN NOT BE PRODUCED IN SJCH A PLACE. "THIS 
IS THE KITCHEN WHERE BABY'S BREAKFAST IS PREPARED."— DR. SANTEE. 




CO 



. O 



Bull. 56, Hygienic Laboratory. 




37. GOOD TYPE OF MILKING SUIT AND PAIL. 




I- d 
2 2 



Bull. 56, Hygienic Laboratory. 



■ill 
m 

". 




f *1 

«-" 



45. A VERY NEAT, INEXPENSIVE, SMALL, BOTTLING ROOM. 



Bull. 56, Hygienic Laboratory. 



P^fWM**.:, I jH ft 





47. CHILDREN INTRUSTED WITH THE IMPORTANT WORK OF WASHING MILK BOTTLES. 





'•*\£'" *-~ JBt~PBl B I ^B V x *y<BjK 


>. 

_£ 

1 
OS 

-: 
c 

'8 




"So 

>< 
- 

5 


^■IP 



. ~_ ^ g ^ 

f ■■ * 


jifil 




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-151 


h '■ -J 



561 

An average of 13 experiments at Storrs station showed the follow- 
ing results: 

Bacteria in milk from unwiped udders per c. c 7, 058 

Bacteria in milk from wiped udders per c. c 716 

Decrease due to wiping 6, 342 

Fig. 30 is shown in contrast to Fig. 29 in order to illustrate a simple 
and inexpensive method of cleaning cows preparatory to milking and 
to show more strongly the desirability of such work. It is not prob- 
able that cows handled as those shown in Fig. 30 would ever get into 
the condition of the one shown in Fig. 29, but the proprietor of this 
clean dairy considered it necessary to wash and wipe the udders and 
flanks before every milking, in this manner. He is taking no risks in 
lives of infants who may be fed on milk from this dairy. 

Figs. 35 and 36 show a clean exterior and interior. In such a place 
the problem of producing clean milk is much simplified, because the 
surroundings are in clean, sanitary condition. The filthiness shown 
in Fig. 29 could not exist. 

The milker may not be cleanly in person or dress; he may have 
that most filthy of habits, milking with wet hands. The hands are 
usually wet by milking a few streams over them and kept wet by 
repeating the operation from time to time. The filth on the udder 
will ooze out under and through the fingers and drip into the pail. 
No illustration could be obtained showing this condition but it is 
frequently met with in inspection work. 

Milkers too often wear the clothing that has done duty for every 
other work about the farm. Such clothing may contain dirt from the 
hog pen, the chicken coop, the horse barn, or the swill barrel, and is 
entirely unfit to be worn during milking. A clean white milking suit 
has a twofold effect. It will not of itself contaminate the milk, and 
if the milker is required to keep such a suit clean, he must of necessity 
keep everything with which he comes in contact clean. Compare the 
appearance of the milker shown in Fig. 37 with that in Fig. 29. A 
milker can not sit down to a dirty cow and keep himself or the milk 
clean. 

The difference in results between different milkers working under 
the same conditions is strikingly illustrated by Stocking. The aver- 
age of 19 tests in which 2 milkers who had had no training in dairy 
sanitation and 1 milker a graduate of the Connecticut Agricultural 
College showed 17,105 bacteria per cubic centimeter for the untrained 
men and 2,455 for the trained man. The only difference between the 
men was the knowledge of what constituted contamination gained 
by the college graduate, who was a student of bacteriology. 

This example well illustrates the difficulty encountered in securing 
clean milk by means of police regulations only. Education must 

45276°— Bull. 56—12 36 



562 

go first, and the police authority used only in those cases where the 
dairyman persists in wilfully violating his own knowledge in prepar- 
ing his milk for market. 

Any superficial compliance with police regulations becomes a farce 
unless the dairyman understands the principle back of such regula- 
tions. As an example: 

Fig. 38 gives a graphic illustration of blind compliance with such 
regulations. A city ordinance required that there must be so many 
feet of glass in every stable. The barn in the photograph was one of 
the usual type of barn found in Pennsylvania and Maryland. The 
dairyman put in the required amount of glass behind the shutters ! 
This was an extreme case, but the example shows the probable out- 
come of enforcing regulations without giving instruction as to their 
purpose. Fig. 39 illustrates the same thing. The dayman was 
required to provide a milk house. Having no knowledge of the 
purpose of such a house he followed the idea that appealed most to 
him — that of convenience. This led to the ridiculous situation of his 
using a section of the hog house to keep his milk in. The skim and 
surplus milk was thus easily disposed of, but think of the condition 
of the milk that was sent to market after having been kept for some 
hours in such a place. 

But little improvement will come through regulations requiring 
clean cows, clean milkers, and clean methods of milking and handling 
the milk unless the dairyman understands the object of such regu- 
lations and the effect they will have on his work. The officers in 
charge of inspection must be teachers first and policemen only when 
they find that the dairyman will not live up to the instructions given 
him and his knowledge of what is right. 

MILK UTENSILS. 

The milk pail should be made so as to reduce to a minimum the 
amount of dirt and hair that can get into it during the operation of 
milking. Fig. 40 shows various types of pails. The wide top is in 
most common use and is most objectionable. The narrow top in 
some form or other will undoubtedly in time replace the wide top. 
Pails and all other vessels designed to hold milk should be seamless, 
if possible, and where seams must occur they should be flushed full 
and smooth with solder. There should be no place either inside or 
out that can not be reached with the brush in washing. Heavily 
tinned utensils are recognized as the best for milk purposes. Wood, 
galvanized iron, or any material that is rough or porous is unfit for 
milk vessels. 

CLEANING MILK UTENSILS. 

No part of the dairy work is more important than the cleaning of 
the milk utensils, or is so often neglected. It can not be too strongly 
emphasized that dairy utensils must, after the milk is washed from 



563 

the surface with warm water, be scalded with boiling water or steam. 
Nothing short of this will insure clean milk. 

MILK HOUSES. 

Milk must be removed at once from the barn to a clean place for 
cooling. The milk house must be provided with ample supply of hot 
and cold water, the necessary cooler, and other apparatus and supplies 
for handling milk. The surroundings of the milk house should be 
neat and clean and the air at all times free from objectionable odors. 
The following illustrations show good and bad conditions as found in 
inspection work. Figs. 41 and 42 are the exterior and interior views 
of a cheap but good milk house where milk is sold from the farm in 
bulk. Cement finish on the interior would be better than the wood, 
but the success of this place was due to the scrupulous cleanliness 
observed, and under these conditions the wood was unobjectionable. 
Figs. 43 and 44 are two very bad conditions. Fig. 43 shows the tur- 
keys roosting in and around the milk house and on the milk utensils. 
The building is so open that no protection is afforded from dirt and 
intruders of all kinds. Fig. 44 shows very untidy surroundings. 
The barrels of trash and old wheelbarrows clutter up the j r ard and 
make it impossible to keep the premises clean. The door is off its 
hinges and altogether the place is unfit for the handling of milk. 
Fig. 45 shows the interior of a small bottling plant. Xote the cleanli- 
ness of the attendant and the place in general. There is no expensive 
machinery, but the milk sold from this place is pure. Fig. 46 is the 
interior of a farm dairy room where milk is sold at wholesale. The 
room has an untidy appearance. The tank is located so that it will 
collect all the dirt from the floor. The position of the cans makes it 
more than probable that dirt will blow or be swept into them from 
the floor. The ceiling and walls can not be kept clean, there being 
too many places to catch dust and cobwebs. It will be noticed that 
the covers of the cans are not on tight. This is a practice quite com- 
mon and is due to an idea that there must be some way for the bad 
odors to escape. If there are bad odors that should escape it is evi- 
dence that the milk is not clean. Clean milk needs no other aeration 
than that given it during the process of cooling. 

CARING FOR THE MILK. 

The bacterial content of the milk at any time depends upon the age 
of the milk, the initial number of bacteria introduced through process 
of milking and handling, and the temperature at which the milk has 
been kept. Consequently clean milk, quick cooling, and short time 
between milking and consumption are very important factors in 
securing pure milk. 

A careful survey of the milk supply of a number of cities indicates 
that not enough attention is paid to these factors either by producers 



564 

or distributors or by the inspection authorities. Milk should be 
cooled immediately and kept cool until it is consumed. From the 
farm to the consumer often several agencies are employed. Hauling 
to the depot, holding at shipping point, transportation on the cars, 
and the handling in the city milk plants are each steps in the process 
of supplying a city that need intelligent and conscientious care. 

THE CITY DISTRIBUTING PLANT. 

All that has been said about cleanliness, surroundings, and care in 
handling milk on the farm applies to the city plant where milk is re- 
ceived and distributed to the consumer. So far as insanitary sur- 
roundings are concerned it is usually the smaller dealer who is the 
greatest offender. He usually lacks facilities for scalding or steriliz- 
ing bottles and utensils. Fig. 47 shows a condition that is in many 
places too common. Bottles are washed in lukewarm water and no 
provision of any kind is made for sterilizing them. Children are in- 
trusted with the work. Fig. 48 shows a condition somewhat similar, 
but the milk room is in the basement of a house in which the family 
lives. Family affairs and the handling of the milk are brought into 
too close proximity. The basement is dark and illy ventilated. 

Fig. 49 is much worse, the trap door in the sidewalk is the only 
means of entrance for attendants, light, and ventilation. A leaky 
sewer pipe runs across the ceiling of the cellar. To bottle and sell 
milk from such a place should be a criminal offense. 

Figs. 50 and 51 are excellent views of the sterilizing room and the 
bottling room of a high-class city dairy, and show a marked con- 
trast to the preceding illustrations. 

Fig. 52 shows the interior of a modern pasteurizing and bottling 
plant. It is ideal in every way for such work. 

It may be said that to require conditions like those shown in Figs. 
50, 51, and 52 would put all small dealers out of business. This is not 
necessarily true. There is no reason why a small dealer can not be as 
clean and careful in his work as a large one. Anyone handling milk 
in small quantities as shown in Figs. 47, 48, and 49 could maintain a 
place like that shown in Fig. 45, which is on a dairy farm. If they 
could not the health of the public demands that they quit the business. 

THE SCORE-CARD SYSTEM OF INSPECTING DAIRIES. 

For the past three years the Bureau of Animal Industry through 
the Dairy Division has been making a thorough investigation of the 
milk supply of a large number of cities of the country with a view of 
establishing a system of inspection and reporting on dairies that would 
be complete, comprehensive, and meet the needs of the public in im- 
provement of the milk supply. Doctor Woodward, Health Officer of 
the District of Columbia, was the first to introduce a score-card system 
of reporting on dairies. A little later Prof. E. A. Pearson, of Cornell 
University, introduced a card for the same purpose. These cards had 



565 

many good features, and if they had been generally adopted would 
have done much to improve the dairy conditions of the country. 

The Department of Agriculture took up the work with the hope of 
extending the use of the score card and more thorough inspection 
thereby. After three years' work, scoring several thousand dairies in 
all parts of the country, a score card has been adopted which has 
been introduced in a more or less modified form, and is in use in about 
60 of the larger cities of the country and in many smaller ones. The 
following are the forms of the present cards for farm dairies and city 
milk plants : 



[United States Department of Agriculture, Bureau of Animal Industry, Dairy Division.] 

Sanitary inspection of dairies. 

[Adopted by the Official Dairy Instructors' Association.] 

Owner or lessee of farm 

P. O. address State 

Total number of cows Number milking 

Gallons of milk produced daily 

Product is retailed by producer in 

Sold at wholesale to 

For milk supply of 

Permit No Date of inspection ,19 

Remarks 



(Signed) 



Inspector. 



Detailed score. 



Equipment. 


Score. 


Methods. 


Score. 


Perfect. 


Allowed. 


Perfect. 


Allowed. 


COWS. 

Health 


6 

2 

2 
2 




cows. 


8 
6 

6 
2 
2 

3 










Apparently in good 
health 1 

If tested with tuberculin 
once a year and no 


STABLES. 




tuberculosis is found, 
or if tested once in six 
months and all reacting 

animals removed 5 

(If tested only once a year 

and reacting animals found 

and removed, 2.) 

Comfort 


Floor 2 

Walls 1 

Ceiling and ledges 1 

Mangers and partitions . . 1 
Windows 1 

Stable air at milking time 

Barnyard clean and well 






Bedding 1 

Temperature of stable. . . 1 




Removal of manure daily to 




Food (clean and wholesome) . . 


(To 50 feet from stable, 1.) 

MILK EOOM. 

Cleanliness of milk room 




Water 






Clean and fresh 1 

Convenient and abun- 
dant 1 







566 

Detailed score — Continued. 



Equipment. 


Score. 


Methods. 


Score. 


Perfect. 


Allowed. 


Perfect. 


Allowed. 


STABLES. 


2 
4 

4 

3 
3 

1 
1 

3 

1 

1 
1 

2 

.2 




UTENSILS AND MILKING. 

Care and cleanliness of uten- 
sils 


8 

9 

1 
2 

2 
5 

3 
3 










Free from contaminating 
surroundings 1 


Thoroughly washed and 
sterilized in live steam 

for 30 minutes 5 

(Thoroughly washed and 
placed over steam jet, 4; thor- 
oughly washed and scalded 
with boiling water, 3; thor- 
oughly washed, not scalded, 
2.) 

Inverted in pure air 3 

Cleanliness of milking 

Clean, dry hands 3 

Udders washed and dried 6 
(Udders cleaned with moist 
cloth, 4; cleaned with dry 
cloth at least 15 minutes be- 
fore milking, 1.) 

HANDLING THE MILK. 

Cleanliness of attendants 

Mdk removed immediately 
from stable 




Tight, sound floor and 
proper gutter 2 

Smooth, tight walls and 
ceiling 1 

Proper stall, tie, and 

manger 1 

Light: Four sq. ft. of glass per 






(Three sq. ft., 3; 2 sq. ft., 2; 
1 sq. ft., 1. Deduct for un- 
even distribution.) 
Ventilation: Automatic sys- 






(Adjustable windows, 1.) 
Cubic feet of space for cow: 500 
to 1,000 feet 






(Less than 500 feet, 2; less 
than 400 feet, 1; less than 300 






feet, 0; over 1,000 feet, 0.) 




UTENSILS. 

Construction and condition of 


Prompt cooling (cooled im- 
mediately after milking 
each cow) 






Efficient cooling; below 50° F. 

(51° to 55°, 4; 56° to 60°, 2.) 
Storage; below 50° F 










(Clean, convenient, and 






abundant.) 

Small-top milking pail 

Facilities for hot water or 


(51° to 55°, 2; 56° to 60°, 1.) 
Transportation; iced in sum- 










(For jacket or wet blanket 
allow 2; dry blanket or cov- 
ered wagon, 1.) 

Total 




(Should be in milk house, 
not in kitchen.) 
Milk cooler 












MILK ROOM. 

Location of milk room 






Free from contaminating 

surroundings 1 

Convenient 1 

Construction of milk room 






Floor, walls, and ceiling . 1 
Light, ventilation, 
screens 1 






Total 


40 




60 













Score for equipment + score for methods = , final score. 

Note 1. — If any filthy condition is found, particularly dirty utensils, the total score shall be limited to 4t 
Note 2. — If the water is exposed to dangerous contamination or there is evidence of the presence of 
dangerous disease in animals or attendants, the score shall be 0. 



[United States Department of Agriculture, Bureau of Animal Industry, Dairy Division.] 
Sanitary inspection of city milk plants. 



Owner or manager Trade name. 

City Street and No 



fMilk. 



State. 



Number of wagons Gallons sold daily 

(.Cream 

Permit or license No Date of inspection. ,190 



567 





Score. 


Remarks. 




Perfect. 


Allowed. 


Milk room. 


10 




















Construction — 
Floor (3) 


10 

15 
10 

■ 15 

} 20 
1 10 






























Equipment — 


















Durability (2) 


















Milk. 
Handling (12) 






Storage (8) . . . 






Sales room. 
Location (2) 






Construction (2) 


















Wagons. 






Protection of product (3) 






Cleanliness (5) 












Total 


100 













Sanitary conditions are— Excellent. 

Suggestions by inspector 

Signed 



Good Fair. 



Poor 



Inspector. 



Sanitary inspection of city milk plants (reverse side). 
DIRECTIONS FOR SCORING. 

MILK ROOM. 

Location. — If not connected by door with any other building, and surroundings are good, 10; when 

connected with other rooms, such as kitchens, stables, etc., make deductions according to 

conditions. 
Construction.— It good cement floor, and tight, smooth walls and ceiling, and good drainage, allow 10; 

deduct for cracked or decayed floors, imperfect wall and ceiling, etc. 
Cleanliness.— If perfectly clean throughout, allow 15; deduct for bad odors, unclean floor and walls, 

cobwebs, unnecessary articles stored in room, etc. 
Light and ventilation.— If window space is equivalent to 15% or more of the floor space, allow 5; deduc 

1 point for every 3% less than the above amount 



568 

Equipment: 

Arrangement.— Allow 3 points for good arrangement; if some of the equipment is out of doors or 

so placed that it can not be readily cleaned, make deductions according to circumstances. 
Condition. — If in good repair, allow 4 points; make deductions for rusty, worn-out, or damaged 

apparatus. 
Construction — 

Sanitary: If seams are smooth, and all parts can be readily cleaned, allow 2. Deduct for 

poor construction, from sanitary standpoint. 
Durability: If made strong and of good material, allow 2. Deduct for light construction and 
poor material. 
Cleanliness. — If perfectly clean, allow 8 points; make deductions according to amount of apparatus 
improperly cleaned. 

MILK. 

Handling.— If milk is promptly cooled to 50° F. or lower, allow 12 points; or if pasteurized at a tem- 
perature of 149° F. or above and promptly cooled to 50° or lower, allow 12 points. Deduct 1 
point for every 2° above 50°. If milk is pasteurized imperfectly, deduct 6 points. If milk is 
improperly bottled or otherwise poorly handled, make deductions accordingly. 

Storage.— If stored at a temperature of 45° F. or below, allow 8 points. Deduct 1 point for every 2° 
above 45°. 

SALES BOOM. 

Location. — If exterior surroundings are good and building is not connected with any other under unde- 
sirable conditions, allow 2; for fair conditions, allow 1; poor conditions, 0. 

Construction.— If constructed of material that can be kept clean and sanitary, allow 2; for fair con- 
struction, allow 1; poor construction, 0. 

Equipment.— If well equipped with everything necessary for the trade, allow 2; fair equipment, 1; poor 
equipment, 0. 

Cleanliness.— If perfectly clean, allow 4 points; if conditions are good, 2; fair, 1; poor, 0. 

WAGONS. 

General appearance. — If painted and in good repair, allow 2 points; for fair condition, 1; poor, 0. 
Protection of product.— If product is iced, allow 3 points; well protected but not iced, 1; no protection, 0. 
Cleanliness.— If perfectly clean, allow 5; good, 3; fair, 2; poor, 0. 

The use of these cards enables a more perfect study of conditions 
in any city. The results so reported are comparable and can be 
analyzed with greater ease and accuracy. 

The application of the system to the District of Columbia and 
vicinity shows the following conditions : 

Eight hundred and eighty-six dairies were given complete scores, 
of which 526 were in Maryland and 294 in Virginia and 66 in the 
District. 

The average scores are as follows : 

Per cent. 

District of Columbia 53. 44 

Virginia 51. 71 

Maryland 40. 42 

Average of all 45. 03 

The greater bulk of milk comes from four counties in which the 
average score, respectively, is as follows: 

Per cent. 

Loudoun County, Va 55. 00 

Fairfax County, Va 53. 25 

Montgomery County, Md 42. 77 

Frederick County, Md 38. 47 



569 



The following table shows the number and per cent of the whole 
number in each of the three sections, District of Columbia, Maryland, 
and Virginia — scoring between 0-10, 10 and 20, 20 and 30, etc. : 





Virginia. 


Maryland. 


District of Columbia. 


Scoring from — 


Number. 


Per cent 
of all. 


Number. 


Per cent 
of all. 


Number. 


Per cent 
of all. 


Oto 10 














10 to 20 






4 

76 

173 

164 

74 

22 

10 

3 


0.76 

14.44 

32.85 

31.18 

14.01 

4.18 

1.90 

.55 






20 to 30 


7 
44 
83 
89 
53 
14 
3 
1 


2.18 

14.96 

28.23 

30.20 

18.02 

4.42 

1.02 

.34 


2 
7 
13 
21 
13 
9 
1 


3.02 


30 to 40 


10.60 


40 to 50 


19.69 


50 to 60 


31.81 


60 to 70 


19.69 


70 to 80... 


13.63 


80 to 90 


1.51 


90 to 100 















The inspection of the city milk plants showed a better condition of 
affairs in some particulars than the inspection of the farms. 

Seventy-four establishments showed an average score of 72.58 per 
cent; 4 per cent scored 90 or above; 16 per cent scored in the eighties; 
49 per cent scored in the seventies; 25 per cent scored in the sixties; 
6 per cent scored in the fifties. 

The average rating of the dairies and city milk plants in the vicinity 
of Washington does not differ materially from that in other parts of 
the country. The cities that have adopted the score-card system and 
are regularly following it up are reporting dairy conditions constantly 
improving. Dealers take advantage of the situation and bid up on 
the high-scoring dairies and thus encourage better work on the part 
of the farmer. The dairymen want a high score and by studying the 
points in the score card are able to improve their conditions. On sub- 
sequent inspection they get a better score in almost every instance. 

A number of cities publish from time to time in the local papers or 
through boards of health circulars the complete results of the score. 
This publicity has a very stimulating effect in inducing the dairymen 
and milk dealers to improve their conditions. 

Perhaps not the least valuable part of the score-card system is 
the demand it makes for better and more competent inspectors. It 
has usually resulted in the dissatisfaction of inspectors with their 
previous work. The study of the premises in- detail with the view 
of fixing the exact value of conditions requires better and more con- 
scientious work. Wherever the system has failed, and there have 
been but one or two such, it has failed because the inspector did not 
relish the comparison of the results with his previous work. 



570 

The photographs shown in this article were all taken in the course 
of inspection work. Many of them were taken in the vicinity of 
Washington, but duplicates of these places may be found in all parts 
of the country. They show that more rigid inspection is absolutely 
necessary, that competent inspectors must be employed to instruct, 
and where instruction is not sufficient, to demand a better state of 
affairs. Laws and ordinances must be strengthened and the public 
educated to demand clean milk from clean dairies. 

One important item that must be borne in mind is the fact that 
to change these conditions must create some expense on the producer 
and the consumer must expect to foot the bills. 

A prominent veterinarian in Kansas City, Mo., recently said in 
connection with the milk supply of that city, that the prevailing 
price of milk was based on a system which required only that the 
solid and coarsest dirt be strained out. If the consumer wanted 
milk that had been kept free from such contamination he would have 
to pay for the added cost of production. 

In order to carry into effect such a system of inspection it is recom- 
mended that there be an inspector for approximately every 100 dairy 
farms. These inspectors should be skilled in all questions pertain- 
ing to the production and distribution of milk. Five of every ten 
inspectors so employed should be skilled veterinarians and the other 
five should have had training in a good dairy school or have had 
experience which would be the equivalent of such training. 

Inspectors should devote their entire time to the work of inspection 
and should not be allowed to do outside work that in any way relates 
to the business of inspection. There should be a chief inspector 
whose duty it is to supervise all work of inspection; he should be 
responsible to the health officer. The health officer, or board of 
health, should have full power to make rules and regulations and 
enforce the same so as to safeguard the health of the community 
from a contaminated milk supply either through carelessness, igno- 
rance, or malicious intent. 

The following suggestions might well be distributed by the health 
officer and the requirement be made that they be posted in a con- 
spicuous place in every barn, dairy house, and city milk plant: 

TWENTY-ONE SUGGESTIONS. 

THE COWS. 

1. Have the herd examined frequently by a skilled veterinarian. Promptly remove 
any animals suspected of being in bad health. Never add an animal to the herd until 
certain it is free from disease, especially tuberculosis. 

2. Never allow a cow to be excited by hard driving, abuse, loud talking, or unnec- 
essary disturbances; do not unduly expose her to cold or storms. 



571 

3. Clean the entire body of the cow daily. Hair in the region of the udder should 
be kept short. Wipe the udder and surrounding parts with a clean, damp cloth before 
milking. 

4. Do not allow any strong flavored feed, such as garlic, cabbage, or turnips, to be 
eaten except immediately after milking. 

5. Salt should always be accessible. 

6. Radical changes in feed should be made gradually. 

7. Have fresh, pure water in abundance, easy of access, and not too cold. 

THE STABLES. 

8. Dairy cattle should be kept in a stable where no other animals are housed, pref- 
erably without cellar or storage loft. Stable should be light (4 square feet of glass 
per cow) and dry, with at least 500 cubic feet of air to each animal. It should have 
air inlets and outlets, so arranged as to give good ventilation without drafts of air on 
cows. The presence of flies may be reduced by darkening the stable and removing 
the manure as directed below. 

9. The floor, walls, and ceilings of the stable should be tight, walls and ceilings 
being kept free of cobwebs and whitewashed twice a year. There should be as few 
dust-catching ledges and projections as possible. 

10. Allow no musty or dirty litter or strong-smelling material in the stable. Store 
manure under cover at least 40 feet from the stable in a dark place. Use land plaster 
daily in gutter and on floor. 

THE MLLK HOUSE. 

11. Cans should not remain in the stable while being filled. Remove the milk of 
each cow at once from the stable to a clean room; strain immediately through cotton 
flannel or absorbent cotton; cool to 50° F. as soon as strained, store at 50° F. or lower. 
All milk houses should be screened. 

12. Milk utensils should be made of metal, with all joints smoothly soldered, or, 
when possible, should be made of stamped metal. Never allow utensils to become 
rusty or rough inside. Use milk utensils for nothing but handling, storing, or deliv- 
ering milk. 

13. To clean dairy utensils use pure water only. First rinse the utensils in warm 
water; then wash inside and out in hot water in which a cleansing material has been 
dissolved; rinse again; sterilize with boiling water or steam; then keep inverted in 
pure air that may have ready access, and sun if possible, until ready for use. 

MILKING AND HANDLING MILK. 

14. The milker should wash his hands immediately before milking and should milk 
with dry hands. He should wear a clean outer garment, which should be kept in a 
clean place when not in use. Tobacco should not be used while milking. 

15. In milking be quiet, quick, clean, and thorough. Commence milking at the 
same hour every morning and evening and milk the cows in the same order. 

16. If any part of the milk is bloody, stringy, or unnatural in appearance, or if by 
accident dirt gets into the milk pail, the whole mess should be rejected. 

17. Weigh and record the milk given by each cow. 

18. Never mix warm milk with that which has been cooled, and do not allow milk 
to freeze. 

19. Feed no dry, dusty feed just previous to milking. 

20. Persons suffering from any disease, or who have been exposed to a contagious 
disease, must remain away from the cows and the milk. 

21. It is needless to say that the shorter the time between the production of milk 
and its delivery, and between delivery and use, the better will be the quality of the 
milk. 



17. SANITARY WATER SUPPLIES FOR DAIRY FARMS. 



(573) 



SANITARY WATER SUPPLIES FOR DAIRY FARMS. 



By B. Meade Bolton, M. D., 
Biochemic Division, Bureau of Animal Industry, Department of Agriculture. 



The importance of sanitary water supplies for farms is not con- 
fined to the farmer himself and his immediate family, but it extends 
to the whole public. All products of the farm with which water 
comes in contact may be rendered dangerous to health by polluted 
water. All fruits and vegetables and receptacles used for collecting 
and shipping food and the hands of those who collect and pack farm 
produce may be infected by washing in impure water. The infec- 
tion in this case arises from the bacteria contained in the water, and 
after the bacteria are once conveyed to the food they increase very 
rapidly under conditions favorable to them. Many kinds of food 
furnish a favorable soil for the growth of bacteria, and this is par- 
ticularly the case with milk. Milk constitutes in fact one of the very 
best media for the development of many kinds of bacteria. Even 
with great care and cleanliness in milking, the bacteria which get 
into the milk quickly multiply to many thousands, unless the milk 
is kept cold. Bacterial contamination of milk arises not only from 
dust, hair, and filth at milking, but also comes from polluted water 
used by milkers for washing the hands, the udders, the milk pails 
and cans. The drops remaining in the can after rinsing with impure 
water are sufficient to contaminate all the milk put into the can, and 
the bacteria introduced into the milk in this way multiply rapidly, 
unless the milk is kept very cold. The danger from polluted milk is 
not only that there may be microbes present which may cause special 
diseases, such as typhoid fever and scarlet fever, but also that many 
bacteria cause changes in the milk which make it injurious to health, 
particularly injurious to children. In this case the bacteria them- 
selves may be of such a kind as not to produce disease if taken into the 
stomach alone, but they may nevertheless change the milk so as to 
make it to all intents a poison. 

The same thing is true more or less with all food, particularly with 
food which is eaten raw, but it is especially the case with milk. 

It may not be out of place to correct an erroneous idea which 
seems quite prevalent in regard to milk contamination through 

(575) 



576 

polluted water. The belief among farmers appears to be quite wide- 
spread that milk may become contaminated by the impure water 
drunk by the cows, the conception being that in some way bacteria 
pass from the stomach of the cow through the udder into the milk. 

There seems no good reason for believing that this takes place. It 
is true that milk becomes tainted by garlic and weeds which the cow 
eats, but this is a very different matter from the passage of bacteria 
from the cow's stomach into the milk. The danger from bacteria in 
milk arises mainly if not wholly from the use of unclean vessels, and 
from slovenly methods of handling the milk in the case of healthy 
cows. It is true that if the cow is diseased, particularly if tubercu- 
losis exists or disease of the udder, bacteria may get into the milk 
from the cow. 

While it is true as just stated that bacteria from foul water does 
not pass directly from the stomach of the cow into the milk, it is 
nevertheless important for the health of the cow to have an abund- 
ance of pure water to drink. 

REQUIREMENTS OF A SANITARY WATER SUPPLY. 

The three factors necessary for a sanitary water supply are purity, 
abundance, and convenience. The most important of these factors, 
and that which has received most consideration as a rule is purity. 
It is the most obvious of the three in importance, since people natu- 
rally prefer clean, pure water, and they are generally educated to 
the dangers arising from polluted water as a possible source of in- 
fection. Hygienic examinations of water supplies often begin and 
end with a determination of bacteriological or chemical contamina- 
tion to the neglect of the questions of proper location, abundance, 
and convenience. Now, while it is quite proper that the purity of 
the water should receive the first consideration, the other two factors 
can not be safely ignored. The water may be pure and sufficient 
for drinking purposes, and yet not in sufficient amount for cleanli- 
ness. For sanitary purposes it is essential that the water should 
be in such quantity that there is no need for stinting in any direction. 
It is essential to have abundance for personal cleanliness, for the 
laundry, for washing the utensils of the kitchen or dairy, and for the 
premises generally. It should be abundant at all seasons. The im- 
portance of the unrestricted use of water is so great that some hygien- 
ists for this reason condemn the use of water meters in private houses 
in cities with a central water supply, because many people are apt 
to stint themselves if the water is paid for by the amount used. 

Convenience is probably the least important factor, but it is never- 
theless essential for a sanitary water supply. It seems from the 
result of the inspection of about 300 farms around Washington that 



577 

this requirement is more neglected than the matter of pollution or of 
abundance. Most farmers take pride in what they regard as the 
purity and abundance of their water supply. Each one in the 
neighborhood will frequently boast of his spring or well in these 
respects, but many of them will year after year haul the water up in 
a bucket out of an open well or pump the water by hand into a pail 
or bring it by hand up hill from the spring. Where such exertion 
as this is necessary in good and bad weather alike persons will resort 
to economy in the use of water for cleaning purposes at least. 

No one rule for preserving health is more important than cleanli- 
ness, the frequent bath, clean underwear, cleanliness of vessels used 
for food, particularly cleanliness of receptacles for milk, cleanliness 
of dwelling and stable. Nothing is so conducive to cleanliness as an 
abundant and convenient supply of clean water and anything which 
facilitates the unrestricted use of pure water is in itself a hygienic 

measure. 

SOURCES OF WATER SUPPLY. 

Of the water which falls to the earth as rain, hail, or snow, a large 
part is evaporated and taken back up into the air. Of the rest a 
part runs off to feed the brooks and rivers, and a part sinks into the 
soil. It is mainly the portion which sinks into the ground which is 




Fig. 53.— Geological formation favorable to the obtaining of water by means of artesian wells. 
Harrington: Practical Hygiene; Phila. and N. Y., 1901, p. 321. 

of interest as a source of domestic water supply for the farm, for it 
feeds the springs and wells. It percolates through the soil until it 
reaches the so-called " water table" which is a more or less porous 
layer of gravel or sand lying upon an impervious stratum of clay or 
rock (see fig. 53). 

45276°— Bull. 56—12 37 



578 

The water table follows the dip of the rock or clay layer and is 
consequently to be found at various depths or it may crop out on 
the surface. Where it crops up it forms a spring where it is tapped 
by a shaft it furnishes the water for a well. If this water table lies 
between two impervious layers, and if the point at which the well 
is sunk is at a lower level than any part of the water table, the water 
flows out and constitutes an artesian well. In order that the water 
may come out at the top of the well it is of course essential that the 
water table should lie between two impervious layers. The upper 
of the two may, however, be at the surface of the ground. A sub- 
artesian well is one in which the water comes up near the top of the 
shaft. 

SOURCES OF POLLUTION. 

Water takes up some part of everything with which it comes in 
contact. Some things, like common salt and potash, as everyone 
knows, are readily dissolved in water, while many other substances 
are dissolved in very small traces; but the solvent action of water 
even on the hardest stone may be noticed in time. Not only solid 
substances, but gases and liquids, as well as living micro-organisms, 
microscopic plants and animals, and minute particles of dust are all 
taken up by water. From this fact it is evident that everything 
with which it comes in contact from the time it leaves the ocean as 
clouds to the time it returns to the ocean as rivers is taken up by the 
water to a greater or less extent. In other words everything which 
is found either dissolved or floating in water except such substances 
as are introduced directly, either intentionally or by accident, is 
derived from the air or soil through which the water passes on its way 
from the ocean and back again. On its way through the air the 
water takes up various gases — oxygen, nitrogen, carbon dioxide, 
ammonia, and other substances of this nature as well as fine dust 
particles and bacteria. On its passage through the soil it dissolves 
various minerals from the rocks, such as lime and magnesia, and if 
the soil is polluted in any way, it takes up whatever it can dissolve 
of the pollution. In the upper layers of the soil the water also comes 
in contact with bacteria which cause its contamination. 

Many of the substances taken up by the water are harmless or even 
beneficial, others are undesirable, while others again may be harmful 
in themselves or indicative of former pollution. The nitrogen and 
ammonia from the air are probably without significance from a sani- 
tary point of view, though these may be of some value in a different 
direction, as a source of food for growing plants. The oxygen and 
carbon dioxide serve a useful purpose in giving life and sparkle to 
the water and in this way impart an agreeable taste. The bacteria 
which the water takes from the air are probably seldom of any signifi- 



579 

cance, though it is true that occasionally bacteria of certain diseases 
have been found floating in the air and these may be taken up by the 
water; still this is probably not frequent in rural districts at least. 

The mineral matter taken up from the soil, particularly the salts 
of lime and magnesia, make the water "hard," and although this does 
not affect the health of those who take the water, unless the minerals 
be present in large amounts, it makes the water less suitable for pur- 
poses of cleanliness. The presence of sewage is of course an indi- 
cation at least that the water may be injurious to health; for as every- 
one knows outbreaks of typhoid fever and of disorders of the bowels 
have been frequently traced to water that was polluted with sewage. 

The substances other than the bacteria taken up by the water are 
not themselves injurious, but they may be more or less significant of 
pollution. Since the disease-producing property of polluted water is 
due to the bacteria which it contains, it would be obviously of the 
very greatest advantage to be able in any given case to detect the 
presence of the pathogenic organism concerned. It goes without 
saying that it would be very desirable to be able to state in a given 
case that the germ of typhoid fever or of scarlet fever or of dysentery 
were or were not present in the water. Unfortunately our knowl- 
edge has not yet been advanced to the point at which this is possible. 
There are many instances on record where epidemics of typhoid fever 
have been traced to certain water supplies, and yet the most pains- 
taking search has failed to show the presence of the bacterium which 
is generally regarded as the cause of typhoid fever. In fact the cases 
are comparatively rare in which this organism has been claimed to be 
detected in water which seemed beyond doubt to be the cause of 
typhoid fever. The most that can be accomplished by chemical 
analysis and bacteriological examination of water at present is to 
show with more or less certainty the presence of pollution with sew- 
age. It is not possible to state positively as a result of these tests 
that any given specimen of water, even though it contain sewage, 
will produce typhoid fever or other gastro-intestinal disorders when 
taken into the stomach. But it is quite possible by these means to 
show that water is more or less polluted and consequently a menace to 
health. This is after all probably as useful from a practical sanitary 
point of view as the ability to detect the specific organism of disease 
would be. If by any means it can be shown that a water supply is 
polluted or even suspicious this is reason sufficient for taking steps 
to present the continuance of the pollution or failing in this to con- 
demn and close the source. 

It is rarely possible to form a just opinion simply by the examina- 
tion of samples of water sent from a distance, for there are other 
factors to be taken into consideration. The decision in regard to 



580 

the potability of water in any given case is a matter often requiring 
very careful consideration of the results of analysis, along with a 
sanitary survey and a knowledge of the normal standards for pure 
water in the section from which the sample is obtained. In forming 
a judgment the inspection of the premises &nd the normal standard 
of other waters in the same region coming from demonstrably unpol- 
luted sources must be taken into account. Injustice and hardship 
have unquestionably resulted from the condemnation of water sup- 
plies on chemical and bacteriological examinations alone, without 
regard to local conditions. The standards of purity should be estab- 
lished for each neighborhood for itself by the analysis of samples 
from several supplies of unpolluted water in the locality. It by no 
means follows that what has been found as a standard for Massa- 
chusetts or Michigan can be used as a standard for Maryland and 
Virginia, nor that the standard for even one section in Virginia or 
Maryland can be used as a standard for another part of the same 
States. In fact, of some 150 water supplies on farms in Virginia 
recently examined, it was very apparent that certain substances 
regarded as indications of pollution were present in unquestionably 
uncontaminated waters in some localities in greatly larger amounts 
than pure water in other localities in the same section. It does not 
seem justifiable in the light of the data obtained in the examination 
of these supplies to take the standards laid down in the books as a 
mechanical and inelastic measure of the purity of these waters. In 
the statements just made the chemical examination of water was 
specially had in mind, but the statements apply equally well to bac- 
teriological examination, particularly to bacteriological examination 
made of water shipped from a distance where judgment is pro- 
nounced without reference to local conditions or other modifying 
circumstances. 

As in the case of the chemical examination, the bacteriological 
examination as a rule merely indicates the probabilities in regard to 
pollution; it does not give in most cases at least positive information 
as to the presence or absence of organisms which would cause this, 
that, or the other disease. It is, moreover, a matter of experience 
that the results of a bacteriological examination made at one time 
may differ very decidedly from that made at another time of the 
same water under apparently the same conditions. In regard to 
the detection of Bacillus coli communis, which is at present regarded 
by many as a more or less trustworthy indication of contamination, 
recent examination of the water supplies in Virginia has shown that 
this organism was present at one time and not present at another in 
the same water supply. 

The significance of the colon bacillus in the dairy water supplies 
will be discussed in a different paper. It is merely referred to here 



581 

for the sake of illustrating the variations which may occur in the 
results of a bacteriological examination of water. 

What has just been said in regard to the chemical and bacterio- 
logical examination of water does not apply of course to the applica- 
tion of chemical and bacteriological examinations in general. On 
the contrary, it is possible to detect specific causes of disease by 
these means in many cases. One need only recall the value of the 
chemical and bacteriological examinations of urine in diseases of the 
kidney and bladder, and of the value of bacteriological examina- 
tions in cases of suspected tuberculosis and diphtheria. But on the 
other hand while such examinations of water supplies may be of 
very great value, they give us only the probabilities in the case, 
and these probabilities are open to some difference of opinion as to 
their weight. The more experience the observer has had the less 
inclined he is to make arbitrary standards and the more capable is 
he of forming a correct judgment in his interpretation of the results 
of his examination. In the examples given above of the detection 
of kidney disease and of the specific bacteria in diphtheria and 
tuberculosis, competent observers will all readily agree in the inter- 
pretation of results. In the matter of the probability of pollution 
of water there is more room for difference of opinion from results 
of analysis. The various statements made in text-books and in 
monographs on hygienic water analysis give ample evidence of the 
want of uniformity of opinion in this respect. It would seem essen- 
tial in all cases to establish a standard of purity for the region of 
country from which any specimen of water under consideration 
comes. 

There are competent observers with abundant experience who are 
inclined to question the value of chemical and bacteriological water 
analysis in toto, and in view of the arbitrary and mechanical manner 
in which the results of these analyses are sometimes interpreted this 
attitude is justified to some extent. It would seem, however, that 
after the establishment of normal standards for a given locality such 
analyses are useful if they are checked by intelligent consideration 
of all the conditions entering into the case but no hard and fast 
rules can be applied. 

PURIFICATION OF WATER IN THE SOIL. 

While water in its passage through the air and through the soil 
becomes contaminated with bacteria which may cause special disease 
or disturbance of digestion, it also undergoes on the other hand a 
process of purification, consisting in a filtration of the particles held 
in suspension. It has been found that at a comparatively short dis- 
tance below the surface, 4 or 5 feet, there are frequently but few bac- 



582 

teria present in the ground , and the water which percolates through 
the soil, although it becomes contaminated in the upper layers, it is 
rid of bacteria on its passage farther downward. Deep ground water 
usually contains few bacteria, but it may become contaminated 
when it is tapped for a well. Of course if the layer of soil through 
which the water percolates on its way to the water table is saturated 
with filth some of the pollution may be carried down, particularly 
if the layer of soil is not thick. 

PROTECTION FROM POLLUTION. 

The water supplies of farms consist of wells, springs, and cisterns. 
A recent inspection of the water supplies of some 300 dairies in 
Maryland and Virginia showed that wells are used much oftener on 
these farms than either of the other two. The proportions are about 
5 wells to 3 springs to 1 cistern. 

Since, as has been stated, the sources of pollution are the entrance 
of sewage or other impurities through cracks and crevices or 



We// 




Fig. 54.— Showing how a cesspool located on high ground may fail to pollute a well lower down. 
Harrington: Practical Hygiene; Phila. and N. Y., 1901, p. 324. 

through a porous soil that has become saturated or finally by the in- 
tentional or accidental introduction of impurities, it is necessary to 
guard against each of these sources. 



WELLS. 

To guard against the pollution of wells the location is of impor- 
tance. Where it is possible the ground should slope away naturally 
on all sides, and the pump should be on top of a mound which should 
be well sodded or cemented all around. Sources of domestic or of 
other pollution should be separated from the well by an impervious 
layer below ground to avoid the danger of pollution from seepage. 

Figure 54 shows how a stratum of rock may protect a well from 
pollution, even where the drainage is toward the well. 



583 

The following figure shows how a cesspool may pollute a well, 
even though the cesspool is at a lower level than the top of the well: 




Fig. 55.— Showing pollution of a well by a cesspool situated on a lower level than the top of the well. 
Harrington: Practical Hygiene; Phila. and X. Y., 1901, p. 324. 

The ground immediately around the well should be protected from 
stray animals by a fence or otherwise. The shaft of the well should 
be thoroughly tight and for this reason the use of terra cotta tiles or 
metal pipe, for the shaft is to be preferred to walling up with bricks 
and mortar. In any event the space immediately around the shaft 
proper should be puddled with clay or cement, or, as advised by Koch, 
have the upper part packed around with sand. The use of open wells 
or even the use of chain pumps is not to be recommended, since they 
are more or less liable to pollution from the introduction of impurities 
down the shaft. In all cases the well should be guarded by a tight 
coping and cover. A device sometimes resorted to, and which is an 
advantage, is to cover over the well with a tight cover and to place 
the pump to one side of the well shaft with an elbow connection. 

A form of well, known variously as the tube, or driven, or Norton, 
or Abyssinian well, is good from a sanitary point of view. It consists 
merely of an iron pipe screwed together in sections driven down to the 
water-bearing layer. The lowest section of pipe is armed with a point 
and is perforated with a number of holes. In a well of this character 
there is no danger from seepage into the shaft and it is cheaply and 
quickly constructed. In case one such well fails to furnish sufficient 
water others can be driven alongside and all connected with one pump. 

Every precaution should be taken to prevent the contents of the 
cesspool soaking into the soil, for even if the cesspool is at a distance 
from the well the ground between will eventually become saturated 
and fail to act as a filter. As stated above, the presence of an imper- 
vious stratum between the well and the cesspool is a good protection, 
but where such a condition does not exist the cesspool should be made 
water-tight. The crude methods of sewage disposal still quite com- 
monly in vogue in the country lead to a continual menace of polluting 
the water supply. 



584 

The photograph, No. 56, is of a well which is imperfectly guarded 
against pollution and with very slovenly surroundings. The situa- 
tion of the well in this case is good. It lies at a considerably 
higher level than the barnyard which is below, and shown in the left- 
hand corner of the picture, and is separated from the well by a ledge 
of rock. The domestic sources of pollution lie to the right and are 
several hundred feet away. The building shown at the right-hand 
corner of the picture is a wood shed. The well is only about 7 feet 
deep, but it is bored into the solid rock and in spite of its want of 
depth, there would appear no good reason why it should not be made 
to fulfill the requirements of a sanitary supply, but when it was 
inspected it was found to have a loose coping and there was no pro- 
vision against pollution due to stray animals. 

Photograph No. 57 shows a well bored into solid rock, and although 
it is only 16 feet deep it would appear to be well protected from any 
source of contamination. Besides the protection afforded by the 
natural rock the curb and cover are tight, and moreover the cover is 
given a slant so as to shed water. 

Photograph No. 58 shows an arrangement which seems to leave 
nothing to be desired. The well in this case is over 100 feet deep 
through rock, the barnyard lies off to the left and is at least 10 or 
12 feet lower than the well. The dwelling is to the left and in front, 
and is still lower and farther away than the barn. The situation of 
the well is inside the building near the top of the hill, seen at the 
right of the picture. This building is the dairy and the floor is 
cemented, and when it was visited it was found to be scrupulously 
clean. 

SPRINGS. 

Much that has been said above in regard to wells applies equally 
to springs, but in addition to the danger of pollution from surface 
drainage and from seepage if the spring is open it is liable to pollution 
from the introduction of impurities in dipping the water out. This 
source of contamination may be guarded against by inclosing the 
spring in a concrete casing on all sides and providing a tight cover 
and a pipe inserted through one side to allow the water to run out. 
The cover should be removable, however, to permit of the cleaning 
out of the sand which always in time accumulates in the spring. 
Instead of the concrete casing a section of wide terra-cotta drain tiling 
set in cement over the point where the water wells up out of the ground 
may be used to good advantage. The tiling should be provided 
with a tight-fitting cover and a pipe to allow the water to run off. 
Either of these two arrangements obviate the danger of polluting 
the water from dipping unclean vessels into it. Some springs excel- 
lently protected by a coping on three sides and in other ways are made 



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585 

liable to pollution by having steps leading down to the water's edge. 
Under such conditions the danger of introducing impurities from the 
soles of dirty shoes is of course apparent. 

Unless a spring has a tight coping on all sides and is provided 
with a tight cover and spout, so that the water does not have to be 
dipped up, it falls short of the requirements of a sanitary supply. 
For convenience the water from the spring should be conducted by 
pipe to the house, dairy, and barn. 

In the recent investigation but few springs were found which were 
properly protected. Some of them had cement or tight stone coping 
on three sides with steps leading down on the fourth side. Some 
had a tight coping on all sides, but the coping was level with the ground 
and the water thus exposed to pollution. But in many cases the 
water ran out of fissures in the rock into a natural or artificial basin, 
or bubbled up from the bottom of such a basin. In these springs 
no special care was exercised to guard against pollution. 

The two photographs, numbers 59 and 60, given here show 
springs surrounded on three sides and over the top by natural rock 
but unprotected on the lower side in each case, and spring No. 44 is 
emote from sources of domestic contamination though it is in a 
pasture lot and is not fenced in. The dwelling is situated above 
and several hundred feet away up the hill shown to the right of 
the picture. The barn is still farther away in the same direc- 
tion. The ground intervening between the house and the spring is in 
sod. The water is pumped up by a windmill to a tank near the 
house. The spring could be perfectly protected with little difficulty. 

Spring No. 60 lies at the foot of the barnyard hill and is shown 
in the picture to the left of the dairy house. Some protection from 
wandering stock is afforded by the railing seen in the photograph. All 
the surroundings were untidy. There was filth up at the very edge 
of the spring. The fence seen to the left in the photograph incloses 
the hogpen, and above to the left is the barnyard, though it is true 
the slope does not incline directly from the barnyard to the spring. 
This is naturally an excellent supply and could be made to fulfill all 
sanitary requirements. 

CISTERNS. 

Where there is no spring and where it is not feasible for any reason 
to sink a well it becomes necessary to resort to cisterns, and if these 
are properly constructed and operated they may be made to fulfill all 
sanitary requirements. The walls should be water-tight, of course, 
both to prevent water from leaking oat as well as to guard against 
pollution from without. The best cisterns are those constructed with 
two chambers divided by a porous brick partition through which the 
water is filtered. The water from the roof is made to run into one 



586 

chamber and is pumped out of the other after passing through the 
partition. The rain pipe from the roof should be provided with an 
arrangement for preventing the first water which falls in time of rain 
from running into the cistern. The advantages of this arrangement 
are obvious, since the first water after dry weather may become pol- 
luted with dust or bird droppings on the roof. It will also serve as 
a cut-off after the cistern is filled. The water should be frequently 
pumped out and the cistern filled with fresh rain. The roof on 
which the rain is caught should be preferably of slate. Water from 
wooden shingles is often tainted. 

ABUNDANCE. 

The above considerations apply only to the purity of the water, 
but as stated in the beginning it is not sufficient for the demands of 
hygiene that the water should be pure, it should also be sufficient in 
amount for thorough cleanliness. The average amount of water used 
in various cities in America and in Europe by each inhabitant per day 
varies greatly, from 15 gallons in Vienna to 100 in Rome, 108 in New 
York, 120 in Detroit, 122 in Chicago, 111. But this amount includes 
the water used for all purposes, manufactories, sprinkling, etc. A 
reasonable average amount for domestic purposes, as stated by Ver- 
non Harcourt, is 25 gallons per day for each individual, and this is 
probably the amount which should be allowed on farms. Since the 
stock is usually watered at running streams this need not be taken 
into account in the reckoning. On farms generally the supply is 
ample. It may occasionally run short in times of prolonged drought, 
but there was no evidence of scarcity on any of the dairy farms 
recently visited. 

CONVENIENCE. 

Comparatively few farmers seem to realize the importance of con- 
venience in the matter of water supplies even from a purely economic 
point of view, and much less from the bearing which such convenience 
has upon cleanliness and consequently upon health. Less than one- 
fifth of the dairy farms recently inspected have windmills, rams, or 
other mechanical means of bringing the water into the house or dairy. 

Year after year on many farms water is pumped by hand or brought 
up the hill from the spring in buckets at the expenditure of a great 
amount of labor in the aggregate. Where it is at all feasible the 
water should be pumped into a tank and conducted at least into the 
dairy and the kitchen by pipe. Even where the water has to be 
pumped by hand it is desirable to have a tank for it insures abundance 
for purposes of cleanliness, but of course, if feasible, resort should be 
had to some mechanical device, windmill, engine, or ram for forcing 



587 

water up to a tank to furnish a convenient supply for the house, 
barn, and dairy, in each of which there should be at least one spigot. 
From the foregoing consideration it is evident that it is not usually 
a difficult matter to comply with all of the requirements of a sanitary 
water supply on the farm. It would appear to present much fewer 
difficulties than the same problem in towns, and seems to require only 
ordinary intelligence in selection of the site and subsequent manage- 
ment besides a certain expenditure of time and money necessary in 
the construction of devices for convenience. Each supply presents 
its own problem which must be solved for itself with proper recogni- 
tion of the objects to be aimed at, and these are parity, abundance, 
and convenience. 



18. METHODS AND RESULTS OF THE EXAMINATION OF 

WATER SUPPLIES OF DAIRIES SUPPLYING 

THE DISTRICT OF COLUMBIA. 



(589) 



METHODS AND RESULTS OF THE EXAMINATION OP WATER 

SUPPLIES OF DAIRIES SUPPLYING THE DISTRICT 

OF COLUMBIA. 



By B. Meade Bolton, M. D., 
Biochemic Division, Bureau of Animal Industry, Department of Agriculture. 



The present investigation was undertaken in cooperation with the 
Dairy Division, Bureau of Animal Industry, Department of Agri- 
culture, and had for its purpose the determination of the general 
sanitary condition by personal observation of the source of the 
supply, whether spring, well, or cistern; the location, surroundings, 
apparent liability of pollution due to proximity to the barnyard or 
domestic source of contamination or to careless and slovenly methods 
of drawing the water; furthermore in each case the purity of the 
water as indicated by the number of bacteria per 1 cubic centimeter 
and the presence or absence of the colon bacillus was determined 
by bacteriological examination of specimens plated on the spot 
and by chemical examination of samples sent as promptly as feasible 
after drawing. The chemical examination was made under the 
direction of Dr. T. M. Price, of the local laboratory in Washington. 
The counting of the plates to determine the number of bacteria and 
the culture tests for the detection of the colon bacillus were made by 
Dr. F. W. Tilley, of the Biochemic Division. Doctor Tilley has also 
assisted in the preparation of the accompanying tables. Dr. E. M. 
Santee, formerly of the dairy division, made photographs in most 
cases, and Mr. Clarence B. Lane, assistant chief of the Dairy Division, 
in others of the water supplies at the farms visited. These have 
all been included in a separate report to the chief of the Bureau of 
Animal Industry. 

The investigation was started April 8, 1907, and was continued with 
some necessary interruption until September 11,1907. It was made to 
include the dairies along the line of the Southern Railway from Vienna, 
Va., to Bluemont, Va., and consequently embraced those dairies 
which ship milk from Round Hill, Purcellville, Hamilton, Sterling, 
Herndon, Paeonian Springs, Clarkes Gap, Leesburg, Belmont Park, 
Ashburn, Wiehle, Hunter, Vienna, and also embraced most or all 
of the dairies around Frederick and Walkersville in Maryland. A 

(591) 



592 

bacteriological investigation had already been made and reported 
upon by Mr. Kellermann, Bureau of Plant Industry, of the dairies in 
the District of Columbia and in the country immediately contiguous 
thereto, and it was not deemed necessary to duplicate this work. 

The method of procedure in the present investigation consisted in 
visiting from 4 to 8 or more dairies a day, and while the inspection of 
the dairies and barns was in progress, cultures were prepared from 
samples of the water, and the source and surroundings of the water 
supplies were recorded in each case upon a specially prepared blank 
form. Below is given a specimen of one of these forms which was 
actually employed. 

In these blanks the parts applicable in each case were underscored, 
and the names, dates, and remarks filled in. In the accompanmg 
blank the words which were underscored in this case are shown, and 
the parts filled in are shown in italics. 
Name, Buckingham Industrial School. Date, 6-10-07. 
Address, Buckeystown, Md. m ' i#Jii , n 

Covered open spring not protected from surface drainage by tight coping. Con- 
ducted through pipe by ram gravity. 

Well bored. Open with bucket and windlass. Pump suction chain. Depth, 109 
feet. Through impervious layer rock. W-'i, 

Cistern. Slate metal shingle roof. No means of turning off first water. Brick 

Pa sTtuation good fair bad. Ground slopes away toward level. Ground not subject 
to pollution with human or animal excrement. 

Remarks: Well situated and well protected in all respects. Pump inside inclosed 
base of windmill tower. Door kept locked. Water conducted through pipe to dairy 
house about 100 yards away. All sources of pollution remote. 
[Front face filled out at the source of supply.] 

Number of colonies per 1 c. c. : 
At 35° C. for 24 hours, 
At room temperature for 48 hours, 210. 

PRESUMPTIVE TEST FOR B. COLi: 

Number of acid-producing colonies on litmus agar per 1 c. c, 63. 
Neutral— red agar: 

Fermentation in one-tenth c. c— In 1 c. c.,+ 

Color in one-tenth c. c. ,— In 1 c - c - > + . 

Milk coagulated, reaction unchanged. Indol reaction present. Diagnosis para- 

colon. 

[Reverse face rilled out at the laboratory.] 

In addition to the cultures, a half-gallon glass-stoppered bottle 
carefully cleaned in the laboratory was filled with the water under 
inspection, and shipped to Washington for chemical examination. 

The media employed for obtaining the cultures consisted m all 
cases of litmus-lactose agar, and neutral-red-lactose agar. These 



593 

media were both prepared without the addition of salt, and the 
reaction was brought to +1.5 American Public Health Association 
scale. The neutral-red-lactose agar contained 0.1 per cent of a 5 per 
cent aqueous solution of neutral red. The litmus-lactose agar was 
employed to make Petri dish plates. The neutral red-lactose agar 
was used for shake tubes. The amounts of water taken for the 
inoculation of the media were the same in each case. A sample of 
the water was caught in a sterilized test tube in each case and a 
melted tube of each of the media was inoculated by means of a grad- 
uated sterile pipette with 0.1 cubic centimeter of the water, and one 
tube each with 1 cubic centimeter. The litmus-lactose agar tubes 
were poured into the Petri dishes, and the neutral-red-lactose agar 
tubes were kept upright until the agar had set, after the water was 
thoroughly mixed with the medium. These plates and tubes were 
shipped to Washington as promptly as feasible, where they were 
taken in charge upon their arrival, and the neutral-red-lactose agar 
tubes were put at once into the incubator at 35° C. and left for 
forty-eight hours. 

In order to protect the pipettes from accidental contamination 
each was wrapped separately in a piece of toilet paper. A special 
double capsule of thin wrapping paper was designed for the protection 
of the Petri dishes. This consisted of two cases, one slipping inside 
the other after the manner of a pocket cigar case. But these were 
abandoned for ordinary manila paper bags, which answer the pur- 
pose very well and are very cheap. The size and kind of bag em- 
ployed were common 2-pound bags with the ends either folded over 
or cut off. The illustration of the traveling kit shows the pipettes 
and Petri dishes wrapped up as described. 

In order to prevent the water, which condenses on the inside of the 
cover of the Petri dishes when the agar is poured, from condensing 
and running on the agar, each dish was covered with a disk of filter 
paper before sterilization. In a dish covered in this way the water 
condenses on the inside of the cover, but it is absorbed by the filter 
paper. 

Various boxes were designed for carrying the necessary apparatus 
into the field, but the field kit which was found most satisfactory, 
and which was most used consists of a light wooden box, 14 inches 
high, 7J inches deep and 5^ inches wide, outside measurements 
(Fig. 61). This box is divided into 2 sections of unequal depth 
hinged together. The shallower section is 2\ inches deep inside, and 
is divided into compartments for holding a square can of alcohol, and 
for test tubes of culture media and empty sterilized test tubes for col- 
lecting samples of water. The deeper section measures 13J inches in 
height, by 4J inches in depth and 4| inches in width, and is divided 

45276°— Bull. 56—12 38 



594 

into compartments for Petri dishes and for an alcohol lamp and a tin 
can for use in melting the media. As will be seen in the figure, 
provision for holding the Petri dishes in the compartment consists of 
a vertical strip of wood on either side of the compartment. These 
strips do not extend up quite to the top, but stop 1 inch short, so as 
to allow for slipping the dishes in in a horizontal position while the 




Fig. 61.— Field kit. 

agar is not yet firmly set. The compartment for the alcohol lamp 
below that for the Petri dishes needs no special description. Clips 
made of a clock spring serve to hold the pipettes, and these clips and 
the 2 cups for holding the ends of the pipettes at the bottom may be 
seen at each side of the compartments for the lamp and the Petri 
dishes. The compartments for the test tubes and extra supply of 



595 

alcohol will be noticed in the illustration. The door which closes the 
compartment for the test tubes is hinged so as to open downward, 
and is kept from falling entirely open by a thin metal stop on either 
side. The lamp (Fig.62) perhaps deserves a few words of descrip- 
tion. It is a vapor lamp of the kind which may be bought in any 
hardware shop. But it was fitted with a gauze cylinder resting on 
the burner, and a thin sheet-tin chimney, which add greatly to 
the heating power, and the tin cylinder also protects the flame 
from the wind. It also served the further purpose of a support for 
the vessel in which the culture tubes were melted. A deep, nar- 
row tin cup with a wooden handle which just fit over the tin 
chimney when inverted was used to boil the water to melt the agar 
tubes. 

In the kit just described it is possible to accommodate test tubes, 
Petri dishes, and pipettes sufficient for making tests from three or 
four places, provided the test tubes are moderately small in caliber 
and the Petri dishes not too deep. The sizes of those which were 
found convenient are test tubes without lips 15 millimeters in diam- 
eter by 150 millimeters long, and dishes 15 millimeters deep by 100 
millimeters in diameter. 

In addition to the above kit, 5 supply cases (Fig,63), also used for 
shipping, were employed. This case, as the accompanying illustration 
shows, consists of a box with a deep lid hinged on, or more properly of 
2 boxes, one of which is shallower than the other, hinged together and 
closed by a catch. One of these compartments is fitted below for 
holding test tubes ; the upper strip seen in the illustration can be 
removed for convenience in taking out the tubes and replacing them. 
The narrow compartment in the upper part is for pipettes. The 
other section is provided with compartments for Petri dishes, such 
as described in the field kit, and also a compartment for pipettes. 
This compartment was used for a supply of sterilized pipettes and 
the compartment for pipettes in the other section was used for the 
pipettes after they had been used. Both sections measure 14 inches 
from front to back and 10 inches from bottom to top. The shallower 
section is 3 inches deep and the deeper section 4J inches deep. The 
compartments for the Petri dishes are 4J inches wide. These are 
inside measurements. The case accommodates Petri dishes and test 
tubes for about 10 tests of the kind already described, each test 
requiring 2 tubes of neutral-red-lactose agar, 2 tubes of litmus- 
lactose agar, 1 sterile empty test tube, 1 pipette and 2 Petri dishes. 
One supply case and the field kit together hold sufficient apparatus 
for about 14 or 15 tests. 

The field kit and one of the supply cases just described were taken 
along each day on the circuit of dairies visited and as soon as the 



596 




597 



plates and the shake cultures in neutral-red-lactose agar were made 
they were transferred to the supply case and this was shipped to 



mm 1 1 1 1 1 | i | 



JLUi 




Fig. 63.— Alcohol vapor lamp with the tin cylinder in place. 

Washington usually in the evening of the day on which the cultures 
were taken. 



598 

The cultures arrived in good condition except in a few cases, and in 
every case it was possible from one or both Petri dishes to make a 
determination of the number of bacteria per 1 cubic centimeter of the 
water. 

It was found desirable to visit a certain number of dairies a second 
time after an interval of about four or five months from the date of 
the first visit, in order to check up and supplement the results ob- 
tained upon the first occasion. 

The results of the investigation are given in detail in a report to 
the chief of the Bureau of Animal Industry which also includes de- 
scriptions of the places visited with photographs of many of them. 
In general the results show that there were 140 places visited in 
Maryland and 15U in Virginia. Of the Virginia dairies, 53 were vis- 
ited a second time. At some of the dairies 2 different supplies were 
used, either 2 wells or a well and spring or either of these and a 
cistern. More wells than either springs or cisterns are used and 
more springs than cisterns. In Maryland there are 92 wells, 42 
springs and 14 cisterns. In Virginia 75 wells, 63 springs and 17 cis- 
terns. 

In assigning a rating from the sanitary survey, account was taken 
of the general lay of the land roundabout, the liability to pollution 
from seepage, and the liability to pollution by direct introduction of 
impurities down the shaft in the case of wells, and into the basin in 
the case of open springs. 

In pronouncing upon the presence or absence of pollution from the 
result of the chemical analysis, it has been necessary to assume some 
limits for purity, and from various statements given in the books and 
from the experience gained in the present investigation a maximum 
of 0.01 parts per million for nitrates, 0.02 for free ammonia and 0.05 
of albuminoid ammonia were adopted as standards. The maximum 
allowed for chlorine varied of necessity for different localities. In 
the Maryland dairies the maximum found in the well water free from 
suspicion was 47 parts per 1,000,000, the minimum was 5. 

In the Maryland springs otherwise free from suspicion the mini- 
mum amount of chlorine was 4 parts per 1,000,000, the maximum 6. 
In Virginia some of the wells which were free from suspicion showed 
as much as 63 parts per 1,000,000; while others showed only 5 parts 
per 1,000,000. Those in Virginia showing the larger amount lie in 
the region with Ashburn for a center and extending west to Leesburg 
and east to Herndon. In this district the minimum amount of 
chlorine was 11 parts per 1,000,000; the maximum 75. Outside of 
these limits the amount of chlorine averaged about 23 parts per 
1,000,000 in the wells which showed no evidence of pollution as far 
as other criteria are concerned. 



599 

The minimum for the springs in Virginia showing otherwise no 
signs of pollution was 2 parts per 1,000,000; the maximum 20. 

In regard to the total number of bacteria per 1 cubic centimeter it 
may be stated that it was not large as a rule and in many cases it 
ran low. In the water from wells in Maryland pronounced good on 
sanitary survey and which showed no evidence of pollution other- 
wise, the number ran from 10 to about 500 per cubic centimeter, 
except in 2 cases where the numbers were 1,580 and 2,900, respec- 
tively. 

In the Maryland wells which were above suspicion the numbers ran 
from 15 to 320. 

In the Virginia wells which were above suspicion the number of 
bacteria per 1 cubic centimeter ran from to 510. In the Virginia 
springs which were above suspicion the numbers ran from to 120, 
except in 1 case where the number ran up to 8,900. 

The presence or absence of B. coli in the water of dairies is perhaps 
of special significance. By some the presence of this organism in 
water is interpreted to signify that the water is polluted with human 
feces and that if this is true typhoid feces may gain access. The 
presence of the B. coli is thus regarded by some as sufficient ground 
for condemning and closing the source of supply in such cases. It is 
true that there are others who are more reserved in their opinion of 
the significance of the B. coli in water and others again who are 
inclined to deny any such significance. It is not the purpose of the 
present paper to discuss the relative merits of any of these views, 
but to merely state what would appear to be the significance 
of the presence of B. coli in the water supply of the dairies under 
examination. 

The occurrence of B. coli in some of the wells with apparently tight 
coping and cover, driven through rock, would seem difficult to 
account for. One case in particular seems remarkable. Well No. 
24 of the Virginia dairies seems peculiarly well situated as regards 
likelihood of pollution of any kind, and 2 chemical examinations made 
about three months apart failed to show any indication of pollution. 
It is situated on the summit of a high hill several hundred yards from 
and 60 or 75 feet above the barnyard, and still farther and higher 
above any dwelling house. The surroundings are all clean. The 
ground is rock and the pump is placed on a high coping which is 
apparently tight. Yet the bacteriological examination showed high 
bacteria count on two examinations, too many in T V cubic centi- 
meter to count in one case and 800 per 1 cubic centimeter in the other. 
B. coli was detected on both occasions. Other examples are not 
wanting in which similar results were obtained. The probability of 
pollution with human feces in all such cases seems very remote if not 



600 

quite impossible. On the other hand it does not seem improbable 
that the cover of the well may have minute cracks between the boards, 
even where inspection fails to reveal any such defects, and that filth 
from the shoes may wash down through these cracks. It is to be 
assumed that this is the case with the well just described and other 
similar wells. 

The presence of B. coli in open springs and cisterns may also be 
more readily explained by assuming its introduction through faulty 
manipulation than by pollution from seepage through the ground. 
In the case of open springs it seems indeed almost unavoidable that 
filth brought in on the shoes should be introduced into the spring. 
In bringing the milk from the cow barn to the dairy more or less cow 
dung is unavoidably tracked on the feet into the dairy and where 
there is an open spring it must be defiled from time to time. As cow 
dung as well as human feces contains B. coli, this would account for 
the frequent presence of the organism in the water from springs at 
dairies. 

But whatever its source, B. coli should be specially guarded against 
in water used for washing vessels for containing milk. For aside from 
the fact that its presence may indicate fecal pollution, human or 
animal, it is likely to get into the milk, and when this occurs it multi- 
plies rapidly and causes changes in the milk which render it unwhole- 
some, particularly for children. 

Still if the supposition stated above is correct that B. coli gains 
access to the water through careless methods in bringing filth on the 
shoes or otherwise, this can be readily remedied in many cases by the 
means recommended in the article on " Sanitary water supplies for 
dairy farms" in this same volume. 

A careful examination should make it possible to decide the cases 
in which the water supplies can be guarded against pollution in the 
manner indicated and those cases where no remedy seems available. 
Even in cases where the chemical and bacteriological examinations 
fail to show pollution, it is sometimes apparent from a sanitary sur- 
vey that a water supply is exposed to accidental pollution from care- 
lessness and that this danger could be avoided by proper coping or 
otherwise. Dairies 103 and 119 in Maryland are examples in point. 
These dairies each obtain water from open springs and the location 
is rendered bad by the fact that in both cases the barnyard drains 
toward the spring and the surroundings in both cases are very slov- 
enly. It would seem that pollution from animal feces at least would 
most certainly occur at frequent intervals. Yet the chemical and 
bacteriological examinations in these cases would indicate excep- 
tionally pure water. The fact that the springs are both very bold 
and the supply of water is constantly being renewed in large quanti- 



601 



ties probably accounts for the discrepancy. In both of these cases 
the supplies might be made to comply with sanitary laws. 

In the following table is a. synopsis of the results obtained in the 
present investigation. 

The symbols used in the column " Sanitary rating" indicate, 
respectively, "G" for good, "B" for bad, and (?) for suspicious; in 
the column "Chemical analysis/' + for more or less evidence of pol- 
lution according to the standards given — for cases in which the 
substances indicative of pollution were found to be within limit pre- 
scribed for unpolluted water; under B. coli communis, + for the 
presence of the organism, — for its absence. Thus in the first line 
it is seen that there were 3 of the wells and 3 of the cisterns in Mary- 
land, and 4 of the wells and 4 of the cisterns in Virginia which were 
apparently good as far as sanitary inspection showed, but which were 
polluted according to the chemical analysis and also contained B. 
coli, while all the springs which are classified as "G" in the table do 
not .all come fully up to sanitary requirements, it was considered 
advisable to classify those as such which have no obvious sources of 
pollution within a short distance and which have more or less pro- 
vision against contamination by way of coping. In reality there are 
very few springs which come up to the requirements stated in the 
article on "Sanitary water supplies for Dairy farms" in the present 
volume. 

Table I. — Maryland dairies. 



Sanitary- 
rating. 


Chemical 
analysis. 


B. coli 
commu- 
nis. 


Number 
of wells. 


Number 

of 
springs. 


Number 

of 
cisterns. 


G 
G 
G 
G 
G 
G 
B 
B 
B 
B 
B 
B 

9 

? 

o 
? 
? 


+ 
+ 

? 
? 
+ 
+ 

? 
? 

+ 
+ 

? 
1 


+ 
+ 
+ 

+ 
+ 
+ 

+ 
+ 


4 

6 
8 
22 
12 
8 
3 
3 
3 
3 

4 




3 

4 
2 




2 
10 
1 
4 
2 
1 
3 
3 
6 
1 


1 

1 








1 
1 


3 

1 
3 
1 
1 








1 





The salient points shown by the above table are that of 60 wells in 
Maryland which were pronounced good on sanitary inspection, 4 



602 

showed chemical and bacterial pollution, 6 showed chemical pollu- 
tion only, 8 showed bacterial contamination only, 22 showed neither, 
20 were suspicious chemically, and of these 20 there were 12 which 
showed the presence of B. coli. 

There were 36 which failed to show the presence of B. coli and 30 
which did not show chemical pollution. 

Of the 17 springs in Maryland pronounced good on sanitary inspec- 
tion, 2 showed bacterial pollution alone, 10 were found to be 
unpolluted either chemically or bacteriologically, 5 were suspicious 
chemically, and one of these showed the presence of B. coli. In all, 14 
did not show B. coli, 10 did not show chemical pollution, and 5 showed 
some evidence of chemical pollution. 

Of the 14 wells in Maryland which were pronounced bad on sanitary 
inspection, 6 showed evidence of chemical pollution, 6 showed no 
evidence of such pollution, and 2 were suspicious. Three showed both 
chemical and bacteriological pollution and 3 showed neither. 

Of the 19 springs classed as bad from the sanitary survey, 6 showed 
evidence of chemical pollution, 6 showed no evidence of chemical 
pollution, and 3 showed neither chemical nor bacterial pollution. 
Seven were suspicious from chemical analysis, and 6 of these con- 
tained B. coli. 

Of 9 springs which were classed as suspicious from the sanitary sur- 
vey, 3 showed neither chemical nor bacteriological pollution. None 
showed both. 

All the cisterns showed either bacterial or chemical pollution or 
both. 

Table II. — Virginia dairies. 



Sanitary- 
rating. 


Chemical 
analysis. 


B. coli 
commu- 
nis. 


Number 
of wells. 


Number 

of 
springs. 


Number 

of 
cisterns. 


G 
G 
G 
G 
G 
G 
B 
B 
B 
B 
B 
B 
? 
? 
? 
? 
? 


+ 
+ 

- 
? 
? 

+ 
+ 

? 
? 

+ 

? 
? 


+ 
+ 
+ 

+ 
+ 

+ 

+ 
+ 

+ 


4 




4 

1 


1 

10 
8 
3 


7 
9 
8 
3 


1 
4 


1 
1 
6 
5 








2 






1 
2 
1 
3 
2 
2 




3 




3 
2 


1 
1 
2 

1 


2 







603 

Table II shows the Virginia dairies visited only once. Of the 31 
wells of this series which were pronounced good on sanitary inspection, 
9 showed neither chemical nor bacteriological pollution, 4 showed 
both, 19 showed B. coli, 16 showed chemical pollution. 

In the springs visited once, 22 were pronounced good on sanitary 
inspection, and 8 of these showed neither chemical nor bacteriological 
pollution, 18 of these showed no chemical pollution, 9 no bacterio- 
logical pollution, 1 showed distinct chemical pollution, and 13 bacterio- 
logical pollution. 

Of the 16 springs which were pronounced bad from the sanitary 
survey, 5 showed neither chemical nor bacteriological pollution, 11 
showed no chemical pollution, 9 showed no bacteriological pollution. 

Only 1 of the 17 cisterns showed neither chemical nor bacterio- 
logical pollution, 7 showed both, and the others showed either one or 
the other form of pollution. 

Table III. — Virginia dairies examined twice. 



Sanitary- 
rating. 


Chemical 
analysis. 


B. coli 
.commu- 
nis. 


Wells. 


Springs. 


G 


| + 
1 + 


+ 
*■ 


) 


1 


i 


G 


f + 


+ 
+ 


1 1 


1 


G 


| _ 


+ 
+ 


r 2 


2 


G 


i + 


+ 


1 l 






G 


j — 


+ 


r 6 


6 


G 


| - 


- 


I l 


1 


G 


1 ? 


+ 
+ 




1 




G 


( ? 


+ 


1 2 






G 


J + 
j + 




1 l 




- 




G 


j ? 
1 ? 


+ 


1 2 





G 


1 ? 


+ 


1 l 


2 


B 


J + 
{ + 


+ 
+ 


1 3 






B 


( ~ 


+ 

+ 




3 




B 


I ? 


+ 




1 




B 


j ? 


+ 




1 




? 


I ' ? 
i ? 


+ 


I 3 







604 



Table III. — Virginia dairies examined twice — Continued. 



Sanitaay 
rating. 


Chemical 
analysis. 


B. coli 
commu- 
nis. 


Wells. 


Springs. 


? 
? 
? 
? 
? 
? 
? 
? 


| + 
1 ? 

f + 

| + 

j + 
1 + 

I ? 


+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 
+ 

+ 

+ 




1 


1 2 

1 1 
1 2 
1 1 
1 1 
1 1 












1 





Table III shows the Virginia dairies which were visited twice. 
Of the 31 wells of this series, 17 were rated good on sanitary survey, 
3 were rated as bad, 11 as suspicious. Only 1 of those rated as good 
failed to show either chemical or bacteriological pollution. The 3 
rated as bad all showed both chemical and bacteriological pollution. 

Of the 21 springs visited twice 14 were rated as good from the 
sanitary survey, 5 were rated as bad, 2 as suspicious. One was 
found unpolluted chemically or bacteriologically on both exami- 
nations, and the others were found more or less polluted either 
chemically or bacteriologically on one or the other visit. 

The above analysis of the results seems to show that there are 
comparatively few water supplies on the dairy farms which were 
visited which are free from sanitary objection, but in spite of this 
fact it is nevertheless probable that in many or most cases the faults 
can be rectified. In fact the faults have already been corrected in 
some cases where they were pointed out to the owners of the dairies. 
It would seem advisible in some cases to close up the source of supply, 
but in most cases all that would seem necessary is to point out to the 
dairymen the sources of pollution, and to give them instructions in 
regard to their avoidance. 



19. THE CLASSIFICATION OF MARKET MILK. 



(605) 



THE CLASSIFICATION OF MARKET MILK. 



By A. D. Melvin, 
Chief of the Bureau of Animal Industry, United States Department of Agri- 
culture. 



In providing for the classification of milk, the primary object is to 
exclude all milk which may be harmful to the consumer and to pro- 
vide for milk that will be wholesome and nutritious. In doing so the 
restrictions should not be more burdensome than is necessary to ac- 
complish this result, and should not be so severe as to lessen mate- 
rially the quantity and so eliminate milk, on account of increased 
price, as an article of diet for the poor. In view of the danger of 
using raw milk from diseased cows, drawn in improperly constructed 
dairies and under insanitary conditions, and improperly handled, it 
is imperative that no raw milk be sold to the public except when those 
in authority know that it is safe to be used in that condition. 

Raw milk of the highest standard should be produced for the use 
of infants and invalids and for those who desire to use only such 
milk and who are willing to pay for the greater cost of production. 
A wholesome supply of raw milk which can be furnished without 
involving unreasonable cost should also be provided for others. A 
third class includes undoubtedly the largest proportion of milk which 
is at the present time furnished for consumption and is unsafe for 
consumption in the raw state. To remove immediately from con- 
sumption this latter supply would result in such an increase in the 
cost of all milk as to place milk as an article of diet beyond the reach 
of the poor. It seems necessary, therefore, to provide some means 
of rendering safe all milk of doubtful quality, and this can be done 
under present conditions only by pasteurization under proper super- 
vision. 

The tuberculin test when applied by the Bureau of Animal In- 
dustry during the period from April 1, 1907, to June 30, 1909, to 
2,471 cows supplying milk to the city of Washington showed that 
15.25 per cent of those tested were affected with tuberculosis, and it is 
believed that just as high a proportion of diseased cows will be found 

(607) 



608 

in the dairy herds supplying many other cities.. These cows should 
be replaced by healthy ones. The work of testing with tuberculin all 
cows supplying milk to a city of considerable size is an immense 
undertaking and must necessarily consume much time. Much time 
is required also in providing suitable cow stables, milk houses, and a 
pure water supply in all instances where such essential features are 
lacking. Facilities must also be provided for delivering milk at a 
reasonable temperature. 

It has been demonstrated that cows showing no physical evidences 
of tuberculosis may be affected with tuberculosis and secrete milk 
containing germs of that disease; also that the feces of such cattle 
are contaminated with that bacillus, and particles of such feces can 
readily gain entrance into milk. It seems important, therefore, in 
any classification of milk for city use, to require pasteurization of all 
doubtful milk for some time, or until all doubt as to the wholesome- 
ness of the milk is removed. 

It is therefore recommended that milk be graded in three classes, 
(1) certified milk, (2) inspected milk, and (3) pasteurized milk, in 
accordance with the specifications following, and that this classifica- 
tion be embodied in laws and regulations and enforced by public 
health authorities. 

CLASS 1.— CERTIFIED MILK. 

The use of this term should be limited to milk produced at dairies 
subjected to periodic inspection and the products of which are sub- 
jected to frequent analyses. The cows producing such milk must be 
properly fed and watered, free from tuberculosis, as shown by the 
tuberculin test and physical examination by a qualified veterinarian, 
and from all other communicable diseases, and from all diseases and 
conditions whatsoever likely to deteriorate the milk. They must be 
housed in clean, properly ventilated stables of sanitary construction, 
and must be kept clean. All persons who come in contact with the 
milk must exercise scrupulous cleanliness and must not harbor the 
germs of typhoid fever, tuberculosis, diphtheria, or other infections 
liable to be conveyed by the milk. Milk must be drawn under all 
precautions necessary to avoid infection, and be immediately strained 
and cooled, packed in sterilized bottles, and kept at a temperature not 
exceeding 50° F. until delivered to the consumer. Pure water, as 
determined by chemical and bacteriological examination, is to be 
provided for use throughout the dairy farm and dairy. Certified 
milk should not contain more than 10,000 bacteria per cubic centi- 
meter, and should not be more than twelve hours old when delivered. 
Such milk should be certified by public health officers or by some other 
properly constituted authority. 



609 

CLASS 2.— INSPECTED MILK. 

This term should be limited to clean raw milk from healthy cows, 
as determined by the tuberculin test and physical examination by a 
qualified veterinarian. The cows are to be fed, watered, housed, and 
milked under good conditions, but not necessarily equal to the condi- 
tions prescribed for class 1. All persons who come in contact with 
the milk must exercise scrupulous cleanliness and must not harbor 
the germs of typhoid fever, tuberculosis, diphtheria, or other infec- 
tions liable to be conveyed by the milk. This milk is to be delivered 
in sterilized containers and is to be kept at a temperature not exceed- 
ing 50° F. until it reaches the consumer. It should contain not more 
than 100,000 bacteria per cubic centimeter. 

CLASS 3.— PASTEURIZED MILK. 

Milk from dairies which do not comply with the requirements speci- 
fied for classes 1 and 2 should be pasteurized before being sold, and 
should be sold under the designation " pasteurized milk." Milk for 
pasteurization should be kept .at all times at a temperature not ex- 
ceeding 60° F. while in transit from the dairy farm to the pasteuriz- 
ing plant, and milk after pasteurization should be placed in sterilized 
containers and delivered to the consumer at a temperature not exceed- 
ing 50° F. 

All milk of unknown origin should be placed in class 3 and sub- 
jected to clarification and pasteurization. No cow in any way unfit 
for the production of milk for use by man, as determined upon phys- 
ical examination by an authorized veterinarian, and no cow suffering 
from a communicable disease should be permitted to remain on any 
dairy farm on which milk of class 3 is produced, except that cows 
which upon physical examination do not show physical signs of tu- 
berculosis may be included in dairy herds supplying milk of this 
class. 

This milk is to be clarified and pasteurized at central pasteurizing 
plants, which should be under the personal supervision of an officer 
or officers of the health department. These pasteurizing plants may 
be provided either by private enterprise or by the municipality, and 
should be located within the city. 

By the term " pasteurization " as used herein is meant the heating 
of milk to a temperature of 150° F. or 65° C. for twenty minutes, or 
160° F. or 70° C. for ten minutes, as soon as practicable after milking, 
in inclosed vessels, preferably the final containers, and after such 
heating immediate cooling to a temperature not exceeding 50° F. or 
10° C. 

45276°— Bull. 56—12 39 



610 

OTHER CONDITIONS. 

No milk should be regarded as pure and wholesome which, after 
standing for two hours or less, reveals a visible sediment at the bot- 
tom of the bottle. 

No dairy farm should be permitted to supply milk of a higher 
class than that for which its permit has been issued, and each dairy 
farm supplying milk of a specified class should be separate and dis- 
tinct from any dairy farm of a different class. The same owner, 
however, may supply different classes of milk, providing the dairy 
farms are separate and distinct. 

The term " milk " as herein used includes cream. 



20. CERTIFIED MILK AND INFANTS' MILK DEPOTS. 



(611) 



CERTIFIED MILK AND INFANTS' MILK DEPOTS. 



By John W. Kerr, 
Assistant Surgeon-General, Public Health and Marine-Hospital Service. 



" She can milk ; look you, a sweet virtue in a maid with clean hands." — Shakespeare. 

The increasing complexity of community life with its attendant 
evils has had an influence in the reduction of maternal feeding of 
infants and at the same time has rendered less accessible a supply of 
wholesome artificial food. 

Educational measures are therefore demanded for the restoration 
of the function of the female breast. In the meantime a pure supply 
of cow's milk for clinical purposes is of vital importance, a fact, 
becoming more and more recognized by physicians and others inter- 
ested in the reduction of infant mortality and the improvement of 
conditions among the poor. 

Its importance is also emphasized by sanitarians, who have reported 
no less than 500 epidemics of typhoid fever, diphtheria, and scarlet 
fever within the last half century in which the infection was trans- 
mitted by infected milk. 

In consequence of a just appreciation of these conditions measures 
have been adopted in various sections of this and other countries to 
prevent the enormous waste of human life which is known to occur 
within the first year after birth — due mainly to a lack of proper food. 

Through private initiative two notable movements were started 
in the United States in 1889 and 1893, respectively; the first had for 
its object the control and distribution of milk to infants of the poor 
and the education of mothers in infant hygiene ; the second, the pro- 
duction under the control of a medical milk commission of pure or 
" certified " milk for clinical purposes. 

CERTIFIED MILK. 

The term "certified milk" was coined by Dr. Henry L. Coit, of 
Newark, N. J., who in 1892 formulated a plan for the production of 

(613) 



614 

pure milk under the auspices of medical milk commissions. This 
plan contained the following general requirements: 

First. That physicians give their practical support to an effort conducted by a 
medical milk commission selected by a medical society which shall endeavor to 
bring to the city a supply of milk produced under such regulations that purity 
shall be assured. 

Second. That approved and trustworthy dairymen possessing honor, financial 
ability, and dairy facilities shall be induced by reason of promised medical 
support and the increased price of their milk to conduct their dairies, collect, 
and handle the product in conformity with the code of requirements made by 
the aforesaid medical commission and imposed by it in due legal form. 

Third. That the duties of the commission shall be, first, to establish correct 
clinical standards of purity for cows' milk ; second, be responsible for a period- 
ical and personal inspection of the dairy or dairies under its patronage ; third, 
to provide for bimonthly expert examination of the dairy stock by competent 
and approved veterinarians and for medical supervision of the employees by 
competent physicians. 

The milk produced shall also be subject to periodical chemical analysis and 
to bacterial counts made under the direction of the commission as often as in 
its judgment is desirable. The experts employed by the commission shall 
render their reports to this body, which constitute the basis of its certification 
of the product. 

The expense of examinations and inspections shall be defrayed by the dairy- 
men ; but the members of the commission shall receive no pay for their services 

The findings of the commission shall be published to the profession only, 
and the milk thus produced shall be known as " certified milk " and be sold 
in quart containers bearing the date of milking and the seal of the commis- 
sion. 

In 1893 the Medical Society of Essex County, N. J., adopted this 
plan and organized the first medical milk commission in the United 
States. 

A dairyman was found who was willing to undertake the produc- 
tion of milk according to the following standards of purity formu- 
lated by Doctor Coit in connection with the original plan : 

First. An absence of large numbers of micro-organisms and the entire free- 
dom of the milk from pathogenic varieties. 

Second. Unvarying resistance to early fermentative changes in the milk, so 
that it may be kept under ordinary conditions without extraordinary care. 

Third. A constant nutritive value of known chemical composition and a 
uniform relation between the percentage constituents of fat, proteid, and 
carbohydrate. 

The following formal contract was therefore signed May 19, 1893, 
under which periodical inspections of the dairy, veterinary examina- 
tions of the herd, chemical analyses and bacteriological counts of the 
milk were instituted : 

° Coit, H. L. Brief history of the development of the pure milk movement in 
the United States. 



615 

Copy op the Agreement Between the Medical Milk Commission op Essex 
County, N. J., and Stephen Francisco, of Caldwell, N. J., Dated May 19, 
1893. 

The following agreement, made this 19th day of May, 1893, between Henry L. Coit, 
M. D., of Newark, N. J., Theron Y. Sutphen, M. D., of Newark, N. J., William B. 
Graves, M. D., of East Orange, N. J., L. Eugene Hollister, M. D., of Newark, N. J., 
Joseph W. Stickler, M. D., of Orange, N. J., and James S. Brown, M. D., of Mont- 
clair, N. J., parties of the first part, and Stephen Francisco, of Caldwell, N. J., party 
of the second part: Witnesseth as follows, that the party of the second part doth hereby 
bind himself to a fulfillment of the provisions of this contract for and in consideration 
of the benefits hereinafter named by the parties of the first part. 

Furthermore, the following-named persons, Frank A. Wilkinson, of Newark, N. J., 
Isaac Lane, of Caldwell, N. J., and William Bush, of Caldwell, N. J., all acquaint- 
ances of the party of the second part, hereby affix their signatures to this agreement, 
attest to the honor of the party of the second part, and become sureties for the execu- 
tion of this agreement. 

1. The party of the second part doth hereby agree to conduct such parts of his dairy 
as may be hereinafter named, collect and handle its products in conformity with the 
following code of requirements, for and in consideration of the promised indorsement 
of the parties of the first part, as hereinafter indicated. The milk thus produced shall 
be known as certified milk, shall be designed especially for clinical purposes, and 
when at any time the demand shall be greater than the supply and is required by a 
physician, either for infant feeding or the diet of the sick, it is hereby agreed that 
such shall be the preferred purchaser. 

2. The party of the second part further agrees to pay for chemical and bacterio- 
logical examinations of the aforesaid certified milk at such times as in the judgment 
of the parties of the first part is desirable. 

3. He also agrees to defray the cost of a bimonthly inspection of his dairy stock, or 
oftener, if necessary, by a competent and approved veterinarian, all of which persons, 
namely, the chemist, the bacteriologist, and the veterinary surgeon, shall be chosen 
by the parties of the first part, to whom they shall render their reports in writing. 

4. It is expressly understood and agreed that the party of the second part shall not 
pay more than the sum of $500 in any one year for the services of chemist, bacteriolo- 
gist, and veterinary surgeon, and the party of the first part shall limit the expense of 
such service to that amount. It is furthermore agreed that the party of the second 
part, on receipt of a certified copy of the reports of the experts, shall mail to the per- 
sons indicated by the parties of the first part, and not to others, a duplicate printed 
copy of the aforesaid reports bearing the signatures of the experts and the names of 
the physicians, the same to be issued at such intervals as in the judgment of the parties 
of the first part is desirable; also that the necessary expenditures for printing and cir- 
culation be met in the same way as herein provided for expert examinations. 

location of lands. 

5. It is hereby understood and agreed that the lands used by the owners, agents, or 
assigns of the dairy conducted by the party of the second part and employed for pas- 
turage, or any lands that may be hereafter acquired for such purposes, or such lands as 
may be used for the cultivation of hay or fodder, shall be subject to the approval of 
the parties of the first part. 

buildings. 

6. It is also understood and agreed that the buildings, such as stables, creamery, 
dairy house, and spring house, shall be constructed after the most approved style of 
architecture, in so far as construction may affect the health of the dairy stock or the 
character and conditions of the milk. 



616 

7. That the buildings used for the housing of the animals shall be situated on ele- 
vated grounds and]capable of being properly drained. 

8. Said buildings to be sheltered from cold winds, lighted, and ventilated accord- 
ing to approved hygienic methods. The buildings shall be constructed so as to favor 
the prompt and easy removal of waste products. 

9. The apartments used for the storage of either feed or fodder shall be removed 
from possible contamination by stable waste or animal odors. 

10. All buildings shall, in addition to healthful location, approved construction, 
and proper ventilation, be kept free from animal or vegetable matter in a state or proc- 
ess of decomposition or decay and always free from accumulations of dust or mold. 

THE WATER SUPPLY. 

11. The dairy shall be supplied with an abundance of pure water. 

12. No water from shallow wells or springs holding surface drainage shall be used 
for watering stock, cooling milk, or cleaning vessels. 

13. Nor shall any well or spring be located within 300 feet of the stable. 

SURROUNDINGS. 

14. It is further understood and agreed that the immediate surroundings of the 
buildings shall be kept in a condition of cleanliness and order. There shall not be 
allowed to accumulate in the vicinity any loose dirt, rubbish, or decayed vegetable 
or animal matter, or animal waste. 

15. Nor shall there be within 300 yards of any building any constantly wet or 
marshy ground or stagnant pools of water. 

16. Nor shall there be kept within 300 yards of any building used for dairy purposes 
any fowl, hogs, horses, or other live stock. 

17. It is hereby understood and agreed that the following unheal thful conditions 
shall be a sufficient reason to exclude any animal from the herd used for any purpose 
in the aforesaid dairy. Any animal that is judged by a competent observer to suffer 
from tuberculosis, even though the disease be localized or latent. 

18. Any animal with fever. Any animal suffering from septic absorption or other 
disease, followed or associated with parturition. 

19. Any animal suffering from mammitis or mammary abscess. 

20. Any animal with persistent diarrhea or any other abnormal physical condition 
which could in any way be detrimental to the character of the milk. 

21. It is furthermore agreed that when an animal shall be found by a competent 
observer to be in a state of ill health, prejudicial either to the other animals in the 
herd or to human health, the same shall be removed immediately and, if necessary, 
shall be killed. 

22. It is also understood and agreed that the party of the second part shall exclude 
from the herd used for producing certified milk, immediately after discovery, any 
animal subject to the following conditions: Any animal that was bred through con- 
sanguinity within a period of three generations. 

23. And from this time forth any animal of those bred by the party of the second 
part used for producing certified milk that was not as a heifer kept sterile during its 
first 27 months. 

24. Any phenomenal milker, except that glandular disease or tuberculosis has 
first been excluded by a competent observer. 

25. It is furthermore agreed that if at any time it is desired by the parties of the 
first part that a different breed of milch cows should be substituted for the one in use, 
in order that the standards of quality in the milk may be raised, the party of the second 
part will endeavor to carry the same into effect. 



617 

HOUSING AND CARE. 

26. It is furthermore agreed that the dairy stock employed in the production of cer- 
tified milk shall be properly sheltered from the influences of weather and climate 
prejudicial to their health, also that the animals shall be kept clean, groomed every 
day, and treated kindly at all times. 

27. The waste products of the stable shall be removed so frequently, and the stable 
floor so thoroughly cleaned, that the same shall be as free as possible from animal 
odors. 

28. It is also agreed that no milch cow shall be used for dairy purposes while in a 
state of excitement, either as a result or during the period of estrux, or which has been 
made nervous either by beating, whipping, kicking, prodding, or running. 



29. It is hereby understood and agreed that the methods of feeding the cows fur- 
nishing the certified milk shall be subject to the approval of the parties of the first 
part. The feed and fodder shall consist only of nutritious and wholesome materials, 
such as grass, clover and timothy hay, whole grain, or the entire result of the grist. 
No materials shall be employed which are or may become injurious to the health of the 
animals. There shall not be fed at any time or in any quantity, either alone or mixed 
with other feed or fodder, hulls, screenings, wet or dry brewer's grains, sour ensilage, 
or any waste by-product in the treatment of grain, low marsh grass, or any of the ques- 
tionable or exhausted feeds or fodders employed either to increase the milking capac- 
ity of the animal or that will produce an impoverished milk or that will impart to it 
unnatural odors or flavors. Nor shall the cows be allowed to eat green or worm-eaten 
fruit, poisonous weeds, or to drink poisonous or stagnant water. 

COLLECTING AND HANDLING. 

30. It is furthermore understood and agreed that the cows from which is obtained 
certified milk shall be milked only in a clean building and not in an illy ventilated 
stable containing foul odors and bad air. 

31. No animal furnishing certified milk shall be milked until the udder shall first 
have been cleaned in a manner approved by the parties of the first part. 

32. No person shall be allowed to draw the milk who has not within fifteen min- 
utes of the milking first washed his or her hands, using soap and nail brush, and after- 
wards thoroughly rinsing the hands in clean water. 

33. The person or persons engaged in milking shall also be dressed in clean over- 
clothes. 

34. No person shall be allowed to draw the milk who has been engaged with the care 
of horses in the same clothing or without first washing his hands. 

35. No milk shall be represented as certified milk that is not received from the 
udder into vessels and from these into cooling cans, both of which are perfectly clean 
and dry, having been cleansed and heated at a temperature adequate to effect com- 
plete sterilization since the last milking, and have been kept inverted in a clean, dry, 
and odorless atmosphere. 

36. No milk shall be represented as certified milk that has not been passed through 
a sieve of wire or other cloth, either while milking or immediately thereafter, having 
not less than 100 meshes to the linear inch. 

37. No milk shall be represented as certified milk that does not consist of the entire 
contents of the udder at each milking, including the fore milk, middlings, and strip- 
pings. 

38. No milk shall be represented as certified milk that has been drawn from the ani- 
mal at abnormal hours, such as midnight or noon, nor from any animal for a period of 



618 

nine weeks before calving, or that has not been separated for nine days after parturi- 
tion. 

39. No milk shall be represented as certified milk which has been exposed to the 
emanation or infection of any form of communicable disease, either in the person or 
persons handling the milk or by accidental contamination in cleaning milk containers 
or by the association of any person engaged in handling the milk with person or 
persons sick of contagious disease. 

PREPARATION FOR SHIPMENT. 

40. It is hereby understood and agreed that all milk represented as certified milk 
shall receive every known detail of care that will promote its keeping qualities and 
favor its safe transportation. 

41. That the milk on being drawn from the cow shall be treated by ice or clean, cold 
water in motion, and proper aeration, in order, first, to remove its animal heat, and 
second, to reduce its temperature to a point not above 50° nor below 40° F., said tem- 
perature to be acquired within forty-five minutes after milking and maintained 
within the above limits while held for shipment, during its transportation, and until 
it is delivered to the purchaser. 

42. That the cooling of the milk shall not be conducted in the same building in 
which it is drawn, nor in an atmosphere containing dust or tainted with animal odors. 

43. That all the foregoing provisions concerning the cleansing and condition of ves- 
sels or utensils shall be complied with in the said cooling process. 

44. It is furthermore agreed that no milk shall be represented as certified milk 
that has been changed or reduced in any way by the addition of water or any solid 
or liquid substance, in or out of solution, or the subtraction or removal, in any manner, 
of any part thereof. 

45. It is hereby understood and agreed that all milk to be represented as certified 
milk shall be packed in flint glass quart jars immediately after it is cooled. 

46. Said jars to be of pattern approved by the parties of the first part. 

47. It is furthermore agreed that the bottles or jars, before being used, shall be 
cleaned by hand, separately, with the aid of hot water, alkaline soaps, rotating brush, 
and steam, and that they shall be rinsed in two separate baths of clean, hot water and 
then thoroughly dried and kept inverted until used, without covers, in a clean, dry 
atmosphere free from odors. 

48. It is agreed that the jars shall be filled by a method approved by the parties of 
the first part. 

49. That they shall be sealed after all air has been excluded by the most approved 
device for closing them. 

50. The bottles after being filled shall be labeled across the cap, bearing the words 
"Certified Milk," with the name of the dairyman, together with the date of milking. 

51. It is furthermore agreed, that no milk shall be sold as certified milk that is more 
than three hours old when bottled nor more than twenty-four hours old when delivered. 

TRANSPORTATION AND DELIVERY. 

52. It is hereby understood and agreed that the transportation and distribution of 
all milk represented as certified milk shall be conducted by the party of the second 
part, either in person or by persons employed by him. 

53. That in transit the milk shall not be exposed to any of the foregoing prohibitory 
conditions. 

54. That it shall not be subjected to agitation. 

55. That it shall not be exposed to the heat of the sun. 

56. That the delivery wagons shall be so constructed that the required tempera- 
ture of the milk may be maintained during transit. 



619 

57. That before the wagons are filled for shipment the body, the trays, and compart- 
ments shall be flushed with boiling water. 

58. It is furthermore agreed that the distributing agents shall, during the transfer of 
the milk from the dairy to the purchaser, be subject to the following restrictions, 
namely, that they shall use no tobacco. 

59. That they shall take no intoxicating drinks. 

60. That they shall not collect the empty containers nor receive money or milk 
checks from houses in which an infectious or contagious disease is known to exist. 

61. It is also hereby agreed that the collection of empty bottles from places where 
infectious or contagious disease is known to exist shall be made by other persons than 
those employed to deliver the milk. 

62. That these collections be made with wagons not employed in the distribution of 
the milk. 

63. That before these empty bottles shall be returned to the dairy they shall be carried 
to a separate building and first be subjected to the process of cleaning bottles indicated 
in a former clause of this contract. 

64. It is hereby understood and agreed that if any further precautions or changes in 
method calculated to improve the quality of milk or guard the same from impurities or 
dangers is desired that the party of the second part will cheerfully be governed by such 
additional rules and regulations as may be laid down by the parties of the first part. 

65. It is understood and agreed by the party of the second part, the same binding the 
owners, agents, or assigns of the aforesaid dairy, that the product known as certified 
milk shall be under the following restrictions in its sale, namely, that until the amount 
required within the boundaries of Essex County shall first be supplied it shall not be 
sold beyond these limits, except that the parties of the first part shall give their consent. 

66. It is furthermore agreed by the party of the second part, the same binding the 
owners, agents, or assigns of the aforesaid dairy, that in the event of a failure to comply 
with any or all of the requirements of the foregoing contract that party of the first part 
shall reserve the right to withdraw from the contract and publish the fact in such man- 
ner as they deem best. 

67. Finally, it is understood and agreed that nothing in this contract shall prevent the 
abrogation of any of the provisions of the same by the parties of the first part, provided 
that it shall be done for the purpose of substituting other provisions designed to promote 
the objects of their organization. 

68. It is further understood and agreed by and between the parties hereto that the 
party of the second part shall be at liberty to cancel this agreement by giving two 
months' notice in writing of his desire to do so, in case of inability for any reason to 
comply with the terms of the same. 

In witness whereof the said parties have hereunto set their hands, the day and year 
first above written. 

At the suggestion of the commission the term " certified milk" was 
copyrighted by the Fairfield Dairy Company (the first to produce 
11 certified milk"), the object being to prevent its use by any except 
medical milk commissions organized for the improvement of dairy 
hygiene. 

The precedent established sixteen years ago has since been fol- 
lowed in many cities of the country, and no less than 56 commissions 
have been organized to encourage the production of pure milk for 
clinical purposes. The plan adopted by these commissions was 
practically the same as that formulated by Doctor Coit, whose 
influence has been so potent in the development of the movement. 



620 

Upon investigation, however, it was found that there was much 
diversity as to working details and standards of purity, and a con- 
ference of the various commissions was held in Atlantic City, June 3, 
1907, to discuss the various complicated phases of the work. 

This resulted in the organization of a national association which 
has for its object the affiliation of all medical milk commissions in the 
United States, the adoption of uniform working methods and stand- 
ards relating thereto, and the extension of the movement in other 
cities. 

It therefore becomes of interest to study more in detail the organ- 
ization of these commissions, their exact functions, their working 
methods and standards, their altruistic motives, and the results thus 
far accomplished. 

THE ORGANIZATION OF MEDICAL MILK COMMISSIONS. 

The commissions have in most instances been appointed by local 
medical societies and practically all of the members were, there- 
fore, physicians. In certain instances, however, commissions have 
been organized by private clubs or medical societies in cooperation 
with local business associations and the membership has included 
men noted for their business acumen and philanthropy. 

The opinion now prevails that the medical milk commission 
should be strictly a medical organization with professional objects 
for the public good and that the majority of its members should be 
physicians. It therefore seems desirable that such commissions be 
created by medical societies and that the members be appointee 
annually. The membership of the different commissions has usually 
consisted of 5 to 12 persons, including a chairman, secretary, and 
treasurer. In two instances at least, notably Cincinnati and Cleve- 
land, representative business men were also included in the member- 
ship, thus lending encouragement and support to the work. 

It has been suggested that the chief sanitary officer of the locality 
should be a member ex-officio of each commission and that this body 
might also act as an advisory to the municipal bureau of milk inspec- 
tions. Such an arrangement would appear to be of mutual advan- 
tage, as the commission might thus lend its influence for the im- 
provement of the general milk supply and in turn be provided with 
laboratory facilities and relieved of undue expense. 

The members receive no pay for their services, but the experts 
employed by the commissions in making the necessary veterinary 
inspections, chemical analyses, and bacteriological examinations 
generally receive fees. In some instances these services have been 
performed by health department officials or gratuitously by private 



621 

persons, and the medical inspections are made by members of the 
commission without compensation. 

FUNCTIONS OF THE COMMISSIONS. 

The nature of the organization precludes the possibility of super- 
vising the production of more than a limited supply of milk, and 
this should be of such quality that physicians could unhesitatingly 
prescribe it for clinical purposes. Different grades of milk, and even 
cream, have been indorsed in some instances, but the original pur- 
pose of the commission would be better subserved by certifying to 
only one grade of milk, and that as pure as can be produced with our 
present methods. Such milk should be available also for use in hos- 
pitals and milk dispensaries, and it is clearly within the province of 
commissions to foster its use in such institutions. Special arrange- 
ments have therefore been suggested whereby such supply can be 
certified for delivery in bulk, provided the containers are sealed. 

In certain instances, it has seemed wise to assume temporarily 
the responsibility of indorsing " inspected milk" (with a bacterial 
count not to exceed 100,000), but this function should properly 
be performed by the municipal authority who is responsible to the 
public for the sanitary condition of the general milk supply. 

The responsibility of the medical milk commission should be 
limited to the production of as nearly perfect milk as possible and 
its reports should be made to the professional body which it repre- 
sents, only simple statements being supplied to the dairies directly 
interested. 

WORKING METHODS AND STANDARDS. 

While the aims and general requirements of the different com- 
missions are similar, there has been considerable diversity in re- 
spect to details, most of them, however, of a nonessential character. 

The original plan outlined the fundamental requirements, and it 
remained for each commission to develop working methods and 
standards suitable to its particular locality. 

In any case, the commission agrees to certify to milk conforming 
to its standards when produced in well-equipped dairies conducted 
in accordance with prescribed sanitary requirements. 

In order that these facts may be determined, a veterinary surgeon, 
a bacteriologist, and a chemist are selected by the commission. 

When a dairyman signifies his willingness to cooperate in the pro- 
duction of pure milk, the veterinary surgeon visits the farm and 
inspects the buildings, their location, and sanitary condition. He 
also observes the hygienic methods employed in the production and 
handling of the milk, and physically examines the cows in the herd. 



622 

This examination also includes the application of the tuberculin 
test. These inspections are subsequently made at frequent inter- 
vals and reports are made to the commission, the following being a 
convenient form in use at Cleveland and other places : 

Inspector's report. Dairy of Date 

Herd : Milking cows Dry cows Hospital cows 

Cows recently calved Cows added since last report 

Not yet tuberculin tested Quarantined 

Stable: Cleanliness Ventilation Temperature 

Dairy building: Cleanliness Ventilation Temperature 

Other buildings 

Utensils 

Care and cleanliness in milking 

Food 

Health of employees 

Remarks 

Based upon the foregoing inspection made at the request of The Milk Commis- 
sion of the city of Cleveland, I beg to report that this dairy conforms to the require- 
ments of said commission and recommend that its milk be submitted to the bacte- 
riologist and chemist for their examinations. 

Signed , Veterinarian. 

The chemist and bacteriologist each examine from time to time 
at the discretion of the commission, samples of the milk taken at 
random or purchased on the open market. 

The former determines the specific gravity, acidity, percentage of 
fats, sugar, proteids, water and mineral matter present, and the 
presence or absence of preservatives and chemical adulteration. 
The latter determines the number, and so far as practicable, the 
character of bacteria and the presence or absence of pus cells. 

The following forms are convenient for rendering the reports of 
these examinations: 

No Dairy Date 

Distributer Collected by 

Sealing Date of milking 

Hour collected Temperature when collected °F. 

General condition: Color Odor Taste 

Separation of cream Macroscopic sediment 

Chemical composition : Specific gravity Acidity Total solids % . 

Fat % . Sugar % . Proteids % . Salts % . Ash % . 

Preservatives Coloring matters Adulterants 

Remarks 

The examination recorded above, made at the request of The Milk Commission 

of the city of Cleveland, shows ai mi [reaching the chemical standard adopted by 

(creamj 
the commission. 

Signed , Chemist. 

[The foregoing card is printed on pink paper.] 



623 

No Dairy Date 

Distributer Collected by 

Sealing Date of milking 

Hour collected Cultures made Temperature when examined °F. 

General condition: Color Odor Taste 

Separation of cream Macroscopic sediment 

Bacteriologic examination: Media 

Temperature Dilution 

Bacteria per c. c Average 

Pathogenic bacteria 

Microscopic examination, blood, pus, tubercle bacilli, etc 

The examination recorded above, made at the request of The Milk Commission 

of the city of Cleveland, shows a J mi I reaching the bacteriological standard adopted 

[creamj 
by the commission. 

Signed , Bacteriologist. 

[The foregoing card is printed on light blue paper.] 
It is generally believed that the bacteriological examination should 
be repeated once a week, the chemical examination once a month, 
and the veterinary inspection once a month — the tuberculin test to 
be used on every new cow added to the herd and reapplied at least 
once a year. 

Inquiry is also made, usually by a member of the commission 
regarding the health of employees, and in addition, the dairyman is, 
in certain instances required to render a regular report regarding the 
presence or absence of communicable diseases among the dairy per- 
sonnel. The following form is used at Cleveland, Ohio, for this 
purpose : 

For the information of The Milk Commission, I hereby answer the following ques- 
tions for the week ending ,19 . 

I. Are any of the men handling milk at your farm ill with any communicable dis- 
ease? 

II. Is there any communicable disease in the families with which they are con- 
nected? 

III. Have any been in contact with any communicable disease and then excluded 
from the milking place? 

IV. Shipments of certified milk and cream in past week: 

(a) Quarts of certified milk (b) Pints of certified cream 

(c) Bottles of certified milk (d) Bottles of certified cream 

V. How many unbroken boxes of caps have you? ". 

Signed 

Upon these reports the commission bases its action in respect to 
certification and the certificates are renewed once a month. 

The danyman is thus authorized to indicate such indorsement, 
either by using on his bottle a cap bearing the name of the Medical 
Milk Commission and the term " certified milk" or a copy of the 
certificate. 



624 

In New York the law forbids the use of the term " certified" on the 
cap unless accompanied by the name of the society which certifies 
it. The laws of Kentucky and New Jersey also forbid unwarranted 
use of the term, and in some other places the certificates bear a 
copyrighted monogram to prevent their fraudulent use. 

The following are examples of these methods of designating such 
milk: 



Philadelphia Pediatric Society. 



MBLX COMMI3S 

September 10 

Milk fr| 
ware Co., Pa M h 
experts of the 
to be up to the re 
examination is 
and, if satisf 
bottles will be issu 
Nottw the Doto*. 



ERTIFICATB. 



Dairy, Dela- 

examined by 

i and found 

rds. Another 

'thin a month, 

labels for the 

dated Oct. 10, 1907. 

\ 





When the certificate form is used it is placed between the cap and 
a parchment covering the neck of the bottle, and in either case the 
date of milking must appear, a rubber or impression stamp being used 
for the purpose. 

In some instances the bottles are hermetically sealed with paraffin, 
which is protected by parchment, tin foil or tin covers bearing the 
term "certified/' the name of the dairy and the name of the Medical 
Milk Commission. The caps are sometimes sold to the dairymen by 
the commissions and funds are thus provided for defraying the nec- 
essary expenses, including inspections, chemical analyses, etc. In 
other instances funds are provided by the medical society, the dairy- 
man or by means of a bottle tax. 

STANDARDS OF PURITY. 

The bacterial content of milk has been accepted as the most practical 
index of the care used in its production and transportation. Bac- 
terial standards for certified milk have therefore been adopted, which 
limit the number of bacteria and require the absence of pathogenic 
organisms. The numerical standard is in most cases a maximam 
limit of 10,000 bacteria per cubic centimeter. The results in differ- 
ent cases no doubt vary somewhat, but with the adoption of estab- 
lished standard methods of technique they should be pretty con- 
stant and capable of comparison. The use of heat and preservatives 
to reduce the number of bacteria are of course forbidden, and to 
determine the absence of the latter, chemical tests are relied upon. 

For the purpose of insuring the constant composition and nutri- 
tive value of certified milk, definite chemical standards have been 



625 

adopted in most cases. Those of the Medical Milk Commission of 
the Philadelphia Pediatric Society are as follows : 

Specific gravity from 1,029 to 1,034; reaction, neutral or faintly 
acid; proteid from 3 to 4 per cent; sugar from 4 to 5 per cent; fats 
from 3J to 4 J per cent; also an additional fat standard of 5 per cent, 
the permissible limits of variation being from 4J to 5§ per cent. 

A knowledge of the fat content is of much importance, and its 
determination at regular intervals is required by all commissions. 
The examination for adulterants and preservatives is of much less 
importance, as it is altogether unlikely that these substances would 
be used by dairymen willing to undertake the production of certified 
milk. 

In order to attain these standards great care is necessary in the 
production and transportation of the milk, and the dairyman is 
required to observe certain rigid requirements. These are codified 
and in some instances incorporated in a rigid contract, which is 
signed by the dairyman and members of the commission. 

REGULATIONS OF THE MILK COMMISSION OF THE MEDICAL SOCIETY 
OF THE COUNTY OF NEW YORK. 

The following requirements of the Milk Commission of the Medical 
Society of the County of New York show great care in preparation, 
and contain all of the essential rules required by other commissions : 

1. The barnyard. — The barnyard should be free from manure and well drained, so 
that it may not harbor stagnant water. The manure whicn collects each day should 
not be piled close to the barn, but should be taken several hundred feet away. If 
these rules are observed, not only will the barnyard be free from objectionable smell, 
which is an injury to the milk, but the number of flies in summer will be considerably 
diminished. 

These flies are an element of danger, for they are fond of both filth and milk, and are 
liable to get into the milk after having soiled their bodies and legs in recently visited 
filth, thus carrying it into the milk. 

Flies also irritate cows, and by making them nervous reduce the amount of their 
milk. 

2. The stable. — In the stable the principles of cleanliness must be strictly observed. 
The room in which the cows are milked should have no storage loft above it; where 
this is not feasible, the floor of the loft should be tight, to prevent the sifting of dust into 
the stable beneath. The stables should be well ventilated, lighted, and drained, and 
should have tight floors, preferably of cement, never of dirt. They should be white 
washed inside at least twice a year, unless the walls are painted or of smooth cement 
finish, which can be washed frequently. 

The air should always be fresh and without bad odor. A sufficient number of lan- 
terns should be provided to enable the necessary work to be properly done during the 
dark hours. The manure should be removed twice daily, except when the cows are 
outside in the fields the entire time between the morning and afternoon milkings. 
The manure gutter must be kept in a sanitary condition. All sweeping must be 
finished before the grooming of the cows begins, so that the air may be free from dust 
at the time of milking. 

45276°— Bull. 56—12 40 



626 

There should be an adequate supply of water, warm and cold, and the necessary 
wash basins, soap, and towels. 

3. Water supply. — The whole premises used for dairy purposes as well as the barn 
must have a supply of water absolutely free from any danger of pollution with animal 
matter and sufficiently abundant for all purposes and easy of access. 

4. The cows. — No cows will be allowed in the herd furnishing certified milk except 
those which have successfully passed a tuberculin test. All must be tested at least 
once a year by a veterinarian approved by the milk commission. Any animal sus- 
pected of being in bad health must be promptly removed from the herd and her milk 
rejected. Do not allow the cows to be excited by hard driving, abuse, loud talking, 
or any unnecessary disturbance. 

Feed. — Do not allow any strongly-flavored food, like garlic, to be eaten by the 
cows. 

When ensilage is fed, it must be given in only one feeding daily, and that after the 
morning milking, and the full ration shall consist of not more than 20 pounds daily 
for the average-sized cow. When fed in the fall small amounts must be given and 
the increase to the full ration must be gradual. 

Cornstalks must not be fed until after the corn has blossomed, and the first feedings 
must be in small amounts and the increase must be gradual. If fed otherwise, ensilage 
and cornstalks are liable to cause the milk to affect children seriously. 

Cleaning. — Groom the entire body of the cow daily. Before each milking wash 
the udder with a cloth used only for the udders and wipe it with a clean dry towel. 
Never leave the udder wet and be sure that the water and towel used are clean. The 
tail should be kept clean by frequent washing. If the hair on the flanks, tail, and 
udder is clipped close, and the brush on the tail is cut short, it will be much easier 
to keep the cow clean. The cows must be kept standing after the cleaning until 
the milking is finished. This may be done by a chain or a rope under the neck. 

5. The milkers.— The milker must be personally clean. He should neither have 
nor come in contact with any contagious disease while employed in handling the 
milk. In case of any illness, in the person or family of any employee in the dairy, 
such employee must absent himself from the dairy until a physician certifies that it 
is safe for him to return. 

In order that the milk commission may be informed as to the health of the employees 
at the certified farms, the commission has had postal cards printed, to be supplied 
to the farms, and to be filled out and returned each week, by the owner, manager, or 
physician of the farm, certifying that none are handling the milk who are in contact 
with any contagious disease. 

Before milking the hands should be washed in warm water with soap and nail 
brush and well dried with a clean towel. On no account should the hands be wet 
during milking. 

The milkers should have light-colored, washable suits, including caps, and not 
less than 2 clean suits weekly. The garments should be kept in a clean place, 
protected from dust, when not in use. 

Iron milking stools are recommended and they should be kept clean. 

Milkers should do their work quietly and at the same hour morning and evening. 
Jerking the teat increases materially the bacterial contamination of the milk and 
should be forbidden. 

6. Helpers other than milkers. — All persons engaged in the stable and dairy should 
be reliable and intelligent. Children under 12 should not be allowed in the stable 
or dairy during milking, since in their ignorance they may do harm, and from their 
liability to contagious diseases they are more apt than older persons to transmit them 
through the milk. 

7. Small animals. — Cats and dogs must be excluded from the stables during the 
time of milking. 



627 

8. The milk. — All milk from cows sixty days before and ten days after calving 
must be rejected. 

The first few streams from each teat should be discarded, in order to free the milk 
ducts from the milk that has remained in them for some time and in which the bac- 
teria are sure to have multiplied greatly. If any part of the milk is bloody or stringy 
or unnatural in appearance, the whole quantity yielded by that animal must be 
rejected. If any accident occurs in which a pail becomes dirty, or the milk in a pail 
becomes dirty, do not try to remove the dirt by straining, but put- aside the pail, and 
do not use the milk for bottling, and use a clean pail. 

Remove the milk of each cow from the stable immediately after it is obtained to a 
clean room and strain through a sterilized strainer of cheesecloth and absorbent cotton. 

The rapid cooling is a matter of great importance. The milk should be cooled to 
45° F. within an hour and not allowed to rise above that as long as it is in the hands of 
producer or dealer. In order to assist in the rapid cooling, the bottles should be cold 
before the milk is put into them. 

Aeration of milk beyond that obtained in milking is unnecessary. 

9. Utensils. — All utensils should be as simple in construction as possible and so 
made that they may be thoroughly sterilized before each using. 

Coolers, if used, should be sterilized in a closed sterilizer, unless a very high tem- 
perature can be obtained by the steam sent through them. 

Bottling machines should be made entirely of metal with no rubber about them, 
and should be sterilized in the closed sterilizer before each milking, or bottling. 

If cans are used, all should have smoothly soldered joints, with no places to collect 
the dirt. 

Pails should have openings not exceeding 8 inches in diameter, and may be either 
straight pails, or the usual shape with the top protected by a hood. 

Bottles should be of the kind known as "common sense," and capped with a steri- 
lized paraffined paper disk, and the caps authorized by the commission. 

All dairy utensils, including the bottles, must be thoroughly cleansed and sterilized. 
This can be done by first thoroughly rinsing in warm water, then washing with a brush 
and soap or other alkaline cleansing material and hot water and thoroughly rinsing. 
After this cleansing they should be sterilized by boiling, or in a closed sterilizer with 
steam, and then kept inverted in a place free from dust. 

10. The dairy. — The room or rooms where the utensils are washed and sterilized and 
milk bottled should be at a distance from the house, so as to lessen the danger of trans- 
mitting through the milk any disease which may occur in the house. 

The bottling room, where the milk is exposed, should be so situated that the doors 
may be entirely closed during the boiling and not opened to admit the milk nor to 
take out the rilled bottles. 

The empty cases should not be allowed to enter the bottling room nor should the 
washing of any utensils be allowed in the room. 

The workers in the dairy should wear white washable suits, including cap, when 
handling the milk. 

Bottles must be capped as soon as possible, after rilling, with the sterilized disks. 

These regulations in effect provide that none but healthy cows 
shall be used in the production of "certified" milk, that extraneous 
contamination of their product shall be reduced to a minimum, that it 
shall be cooled to 45° F. to prevent bacterial growth, and that it shall 
reach the consumer before noticeable biological or chemical changes 
have occurred therein. For their observance the greatest care and 
intelligence is required, and it is necessary that the dairy be of 
modern sanitary construction. 



628 

This does not imply, however, that elaborate and expensive ap- 
paratus is absolutely essential. The surgeon may of necessity be 
forced to convert the kitchen into a surgical ampitheater, but his skill 
and attention to detail will insure an aseptic wound. The same in 
fact is also true of the dairyman, whose conscientious and well- 
directed efforts will yield, even with limited facilities, a product which 
may be impossible of attainment in the elaborately equipped dairy of 
the " agriculturist." 

Much also depends upon the zeal of the professional body under 
whose patronage the dairy operates — a fact clearly evident to one 
visiting these model establishments. 

The sanitary excellence of " certified " milk and the standards it 
represents may therefore be expected to improve in proportion to the 
increasing appreciation of the medical profession and the educational 
attainment of those engaged in dairying and dairy hygiene. 

THE RESULTS ACCOMPLISHED. 

Since the beginning of the movement seventeen years ago, a limited 
supply of pure milk has been rendered available for clinical purposes 
in a number of cities of the country. 

The plan which was originated by a member of the medical pro- 
fession has been the means of arousing that body itself to the impor- 
tance of pure milk for the use of infants, invalids, and the public 
generally. In consequence there has been organized the American 
Association of Medical Milk Commissions, which has held three an- 
nual meetings, and which is organized as for a permanent agency in 
the improvement of milk supplies. 

The methods adopted have had an influence in creating a demand 
for improved conditions in the production of market milk, and in 
addition exerted a beneficial effect upon the character of the general 
supply in those localities where " certified " milk is produced. They 
have also emphasized anew the dangers of bovine tuberculosis and the 
necessity of preventing the use of milk from tuberculous cows. 

The standards of purity have already served as a basis for the 
formulation of measures which it is proposed to enact into law, a 
milk conference in the District of Columbia having recommended 
that " certified " milk be recognized by law and that it be certified by 
the health officer of the District, 

An act was passed by the general assembly of New Jersey and 
approved April 21, 1909, providing for the incorporation of medical 
milk commissions and the certification of milk produced under their 
supervision. 

Finally, the continued interest of the medical profession in the sani- 
tary supervision of milk from the farm to the consumer will result in 
the adoption of new standards of purity far in advance of those in 
use at the present time, 



629 

INFANTS' MILK DEPOTS. 

The milk dispensary, or " goutte de lait," was called into existence 
in consequence of a recognition that bad milk and bad hygiene are 
responsible for excessive infant mortality among families of the poor. 

Its primary object is to encourage maternal feeding, and when this 
is impossible, to supply a pure milk to meet the special need of the 
infant. An additional important function consists in the diffusion 
of knowledge among mothers regarding the hygienic care of their 
children in the home, especially with reference to the conditions nec- 
essary for success in artificial feeding. 

The first institution of this character in the United States appears 
to have been opened by Dr. Henry Koplik at the Eastern Dispensary, 
New York, in 1889." 

During the same year a similar institution was also founded in St. 
Gertrude's district, Hamburg. 5 

In 1892 Doctor Yariot established a " goutte de lait " in connection 
with the Belleville Dispensary, Paris. 

Since 1892 similar establishments have been opened in many local- 
ities in this and other countries, either through private philanthropy 
or governmental agency. 

Although the methods employed in the conduct of infants' milk 
depots have varied somewhat both in this country and abroad,, their 
objects have been the same. It is recognized that all milk dispensed 
should be produced and transported under conditions insuring a prod- 
uct of the highest purity, that it should be prepared and modified in 
the depot under medical supervision, and that strict bacteriological 
precautions should be taken in every step of the process. 

In addition to the care exercised in the depot, the milk is packed 
in a manner to guard against contamination in the home. Each bot- 
tle contains but one feeding, and is so designed that it will not stand 
on end, and therefore can not be left standing open. 

The milk is modified in accordance with standard formulas in use 
at the various depots, and, in addition, special modifications are made 
upon the prescriptions of physicians. 

The following are formulas now in use at the Straus milk depots 
in New York: 

FORMULA FOR MODIFIED MILKS. 

Formula No. 1 {Dr. Arthur R. Green). 

Milk ounces__ 96 

Cane sugar do 2. 5 

Salt do 0.083 

Oat water do 32 

° New York Medical Journal, Jan. 31, 1891, and Feb. 4, 1893. 
6 Von Ohlen, Milk Depots in Germany, Public Health, 1905. 



630 

Formula No. 2 (Dr. Rowland G. Freeman). 

Milk ounces 64 

Limewater do 4 

Milk sugar do 6 

Filtered water do 60 

Formula No. 3 (Dr. A. Jacobi). 

Milk - ounces__ 64 

Barley water do 64 

Cane sugar do 4 

Table salt grains__ 30 

Formula No. 4 (Dr. Rowland G. Freeman). 

Cream (16 per cent) ounces-- 10§ 

Milk. do 214 

Milk sugar. do 6^ 

Limewater do 4 

Filtered water do 92 

Formula No. 5 (Dr. Arthur R. Green). 

Cream (16 per cent) ounces__ 4 

Milk do 16 

Limewater do 6 

Milk sugar do 6 

Filtered water do 102 

The three former mixtures are placed in 6-ounce bottles, the two 
latter in 3-ounce bottles and pasteurized by exposure of twenty min- 
utes to 157° F. Whole milk is also pasteurized in 8 and 16 ounce 
bottles. 

Practically all infants' milk depots in the United States are under 
general medical supervision, and, in addition, many depots are in 
direct charge of graduate nurses who prepare the milk and give in- 
structions to mothers in the care of infants. In some instances, 
visiting nurses also enter the homes of the children for the purpose of 
imparting instruction. 

With the view of determining the extent of this movement and its 
influence on the public health, an inquiry was sent by the Surgeon- 
General of the Public Health and Marine-Hospital Service to the 
health officials of all cities in the United States containing a popula- 
tion of over 50,000. Replies were received from 65 of the 76 cities in 
this class, and acknowledgments are due to the health officers and 
others through whose courtesy the following tabulated information 
was obtained. The information thus obtained is of much interest 
and value. 

The following table contains a list of the cities in the United States 
in which infants' milk depots are located, the dates of their establish- 
ment, the number of depots operated in each city during the season 
of 1907, the period of the year in which they were in operation, and 
by whom maintained : 



631 



Cities in the United 
States having in- 
fants' milk depots. 



When 
estab- 
lished. 


Num- 
ber of 
depots. 


1893 


a 17 


1894 


1 


1897 


4 


1898 


7 


1899 


2 


61903 


28 


cl903 


20 


1903 


9 


1904 


12-15 


1905 




6 1906 


1 


1906 


5 


1906 


5 


1907 


2 


1907 


5 


1907 


2 


1907 


9 


1907 


1 


1907 


3 


(d) 


. io 


1899 


1 


1899 


16 



Period of year in operation. 



Conducted by — 



New York, N. Y. 



Yonkers, N. Y.. 
Rochester, N. Y 
Pittsburg, Pa... 



Cleveland, Ohio . 
Chicago, 111 



Philadelphia, Pa . 
Baltimore, Md 



St. Louis, Mo 

Detroit, Mich 

Columbus, Ohio . . 
Cambridge, Mass. 



Providence, R. I. 
Cincinnati, Ohio 

Jersey City, N. J. 



Newark, N. J . . . 
Brooklyn, N. Y. 



Toledo, Ohio 

Kansas City, Mo 

Kansas City, Kans 

New Bedford, Mass . . . 

Boston , Mass 



7 are open during the en- 
tire year; 10 located in 
parks and on recreation 
piers are open in sum- 
mer. 

June 1 to Sept. 30 

July and August 

May to November; some- 
times to December, de- 
pending upon the weath- 
er. Isolated cases fur- 
nished milk during en- 
tire year. 

Entire year 



22 are open during entire 
year; 6 during summer 
season only. 

9 are open during entire 
year; 11 during summer 
months. 

8 are open during entire 
year; 1 during July and 
August, 1907. 



May to December 

At hospital dispensaries. 



During entire year 



All open during 'summer 
months. 



Open from June 20 to Sept. 
6, 1907. 

Open from July 15 to Sept. 1 . 



Opened July 15; to be main- 
tained during entire year. 



1 open during entire year; 
1 from June to October. 

Aug. 1 to Oct. 1 

Aug. ltoOct. 1 

July 10 to Sept. 10 



5 open during entire year. 
In addition, out-patient 
departments of 5 hos- 
pitals distribute milk 
during summer. 



Maintained by Mr. Nathan 
Straus and conducted by a 
medical director. 



St. John's Riverside Hospital. 

Health department. 

Private philanthropy. Pittsburg 
and Allegheny Milk and Ice 
Association. Supervised by 
medical director and secretary 
of the association. 

Private philanthropy. Milk 
Fund Association. 

Private philanthropy. The Milk 
Commission of the Children's 
Hospital Society. 

Private philanthropy. Philadel- 
phia Modified Milk Society. 

Private philanthropy. Thomas 
Wilson Sanatorium for Chil- 
dren until 1906. Since then by 
The Babies Milk Fund Associa- 
tion. Summer station main- 
tained by Playground Associa- 
tion. 

Private philanthropy under di- 
rection of St. Louis Pure Milk 
Commission. 

Private philanthropy. Detroit 
Milk Fund Association and 
under medical supervision. 

Private philanthropy. Hartman 
Stock Farm Dairy.* 

Public appropriations and pri- 
vate philanthropy. Milk in- 
spector with cooperation of 
Cambridge School of Nursing 
and Visiting Nurses Associa- 
tion. 

Private philanthropy. Commit- 
tee of the Providence Medical 
Association. 

Health department, nurse at 
each station. Physician in 
general charge. 

City board of health. Under 
medical supervision of superin- 
tendent, bureau of contagious 



Summer months 



Private philanthropy. 

Private philanthropy. Kansas 
City Pure Milk Commission. 

Private philanthropy. Kansas 
City Pure Milk Commission. 

Private philanthropy. Charity 
organization society of New 
Bedford. 

Private philanthropy. Hos- 
pital work maintained by a 
" milk fund." 



Executive committee, Society of 
the Babies' Hospital, Newark, 
N.J. 

Brooklyn Children's Aid Society. 



a Depots are also maintained by the Good Samaritan Hospital, The Diet Kitchen Asso 
ciation, and the New York Milk Committee. 
b April. 
c July. 
d First one " many years ago," others about Jan. 1, 1905, 



632 

The above table indicates that there are 22 cities in the United 
States in which infants' milk depots were in operation during the 
year 1907. 

Since the compilation of this table relative to infants' milk depots, 
information has been received as to other depots showing an extension 
of the movement. 

The general secretary of the Brooklyn Children's Aid Society has 
invited attention to the work of that society. He has also reported 
that in New York, in addition to the depots mentioned in the table, 
there are seven milk stations under direction of the New York milk 
committee, and one or more each that are maintained separately by 
the Good Samaritan Dispensary and the Diet Kitchen Association. 

While the first depot was organized in New York in 1889, other 
cities soon took up the work, and during the past two years the move- 
ment has progressed rapidly, no less than 6 cities having organized 
milk depots during 1907. 

It is shown that 159 stations were in operation during the present 
season in the 22 cities from which data was secured, 55 of which will 
be maintained during the entire year. 

In only 4 of the 20 cities were depots maintained at public expense 
and supervised by officials of the municipalities ; all the others owed 
their existence to private philanthrop}^, which has set the example in 
the solution of this great public-health problem, as it has in so many 
others of economic and vital importance to the State. 

The following table contains data regarding the source and char- 
acter of the milk used, whether it was modified under professional 
supervision, whether it was pasteurized and the method followed, and 
the amounts distributed during 1907: 



Cities in which are 
located infants' 
milk depots. 



New York, N. Y... 



Yonkers, N. Y. 



Rochester, N. Y... 



Source and char- 
acter of milk 
used. 



Milk certified by 
the Medical 
Milk Commis- 
sion. 



Plain milk 



Central station 
in charge of 
trained nurse 
located at the 
farm. Cows are 
tuberculin 
tested. 



Whether modified 
and by whom. 



Whether pasteur- 
ized and tempera- 
ture used. 



Modifications are 
prepared in ac- 
cordance with 
formulas of phy- 
sicians. 



Modified under su- 
pervision of phy- 
sician. 

Modified under su- 
pervision of a 
physician. 



All milk is pasteur- 
ized by exposure 
for 20 minutes to 
a temperature of 
157° F. No milk 
is sold twenty- 
four hours after 
preparation. 

Pasteurized by ex- 
posure for 20 min- 
utes to tempera- 
ture of 176° F. 

No 



Amount of milk 
distributed dur- 
ing present sea- 
son. 



From Jan. 1 to 
Sept. 15, 1907, the 
Straus depots 
alone dispensed 
2,917,336 bottles 
and 1,222,045 
glasses. 

60 quarts daily. 



6,000 to 7,000 
quarts delivered 
in nursing bot- 
tles ready for 
use. 



633 



Cities in which are 
located infants' 
inilk depots. 



Source and char- 
acter of milk 
used. 



Whether modified 
and by whom. 



Whether pasteur- 
ized and tempera- 
ture used. 



Pittsburg, Pa . 



Cleveland, Ohio. 
Chicago, 111 



Philadelphia, Pa .. 



Baltimore, Md 



St. Louis, Mo . 



Certified milk 
from Locust 
Grove Farm. 



Dairy scoring 85 . 
Inspected dairy . 



Inspected dairy . 



Burnside Farm.. 



Certified milk 
produced under 
patronage o f 
Pure Milk Com- 
mission. 



A portion is modi- 
fied according to 
physician's pre- 
scription at the 
Walker Gordon 
laboratory. 
Work supervised 
by regular physi- 
cian. 



Brooklyn, N. Y 
Detroit, Mich.. 



No 

4 standard modifi- 
cations are used 
and special modi- 
fication on physi- 
cian's prescrip- 
tion. 

4 standards of modi- 
fication are used. 



Modified and bot- 
tled by the Walk- 
er Gordon labora- 
tory under direc- 
tion of Dr. J. H. 
M. Knox, jr. 

Large proportion 
modified under 
direction of chem- 
ist, who is under 
supervision o f 
physician. 

Yes 



Columbus, Ohio... 



Walker Gordon 
laboratory. 



Hartman Stock 
Farm Dairy, 
tuberculin 
tested herd. 



Modified under di- 
rection of physi- 
cian in charge of 
clinics. 



To be modified, be- 
ginning in spring 
of 1908. 



Cambridge, Mass.. Certified milk Yes. 



Providence, R. I... 
Cincinnati, Ohio. . . 

Jersey City, X.J 



Berrv Farm. 



Milk certified bv 
Medical Milk 
Commission. 



Yes; under medical 
supervision. 

No.... 



Pasteurized milk. No. 



Toledo, Ohio 

Kansas City, Mo . . . 



; Hillcrest Farm 
under best sani- 
tary conditions. 



Kansas Citv, Kans. 1 Modified 



New Bedford, 
Mass. 



Milk, the average 
bacterial count 
of which is 
12,000. 



No 

Modified under 
medical supervi- 



4 standard formu- 
lae used, also on 
special prescrip- 
tion of p h y s i - 
cians. 

Modified for young 
infants by nurses 
upon prescrip- 
tion of physician. 



Modified milk for 
y|oungest chil- 
dren pasteurized 
during period of 
greatest heat and 
humidity. Tem- 
perature" of 157° 
F. for 20 minutes. 



Amount of milk 
distributed dur- 
ing present sea- 
son. 



93,417 feedings of 
modified milk. 
27,355 quarts 
whole milk. 
Double these 
amounts d i s- 
pensed during a 
year. 



No 2,700 quarts. 

Yes. Temperature j 364,126 bottles 



of 165° F. 
minutes 



for 20 j from Jan. 1 to 
Sept. 30, 1907. 



All milk is pasteur- 
ized by exposure 
for 20 minutes to 
a temperature of 
180° F. 

Pasteurized when 
air temperature is 
above 80° F. by 
exposure for half 
an hour to tem- 
perature of 150° F. 

Pasteurized by ex- 
posure for 20 min- 
utes to tempera- 
ture of 167° F. 



823,014 bottles 
from Jan. 1 to 
Sept. 30, 1907. 



Average for the 
year is about 
1,050 bottles a 
day. 



450,000 bottles (2, 
4, 5, 7, and 8 
ounces). 



Yes ! 360,000 bottles 



Not pasteurized, 
except on physi- 
cian's prescrip- 
tion. 



From July to No- 
vember, 1905, 
20,835 bottles of 
modified milk 
and 1,367 quarts 
whole milk. 

Average of 300 
babies supplied 
during first 9 
months of 1907. 

387 quarts of 
milk and 244i 
quarts of cream 
from Jan. 1 to 
Sept. 27, 1907. 

7,413 quarts. 



No ' About 4,000 pints 

distributed 
among 305 fam- 
ilies. 

Pasteurized by ex- \ About 40,000 bot- 
posure for 30 min- j ties from July 




utes to a temner- 
ature of 170° F. 



20, to Sept. 30, 
1907. 



No About4,000quarts. 



Pasteurized by ex- 
posure for 20 min- 
utes to tempera- 
ture of 165° F. 

A portion pasteur- 
ized by exposure 
for 10 minutes to 
temperature 
of 163° F. 



No. 



1,800 quarts a 
month. 



800 quarts of pas- 
teurized milk 
daily; 40 quarts 
ofmodifiedmilk 
in 3-ounce bot- 
tles daily. 

Over 7,000 quarts. 



634 



Cities in which are 
located infants' 
milk depots. 



Boston, Mass. 



Newark, N.J 



Source and char- 
acter of milk 
used. 



'Milk fund" sup- 
ply from Walk- 
er Gordon lab- 
or a t o r y ; the 
rest from se- 
lected country 
dairies. 



"High grade". 



Whether modified 
and by whom. 



Modified "milk 
fund" modifica- 
tions made upon 
prescriptions 
adapted for each 
case. The rest is 
modified accord- 
ing to 3 selected 
formulae. 

Yes 



Whether pasteur- 
ized and tempera- 
ture used. 



Much of "milk 
fund" supply is 
not heated. All 
milk used by 
other organiza- 
tions is pasteur- 
ized at tempera- 
ture of 155° F. for 
20 minutes. 

Pasteurized by ex- 
posure to temper- 
ature of 155° F. 



Amount of milk 
distributed dur- 
ing present sea- 
son. 



"Milk fund" sup- 
plied 300 babies 
in summer of 
1906. Other or- 
ganizations dis- 
tribute about 
1,200 bottles 
daily, 

258,000 bottles to 
over 500 infants. 



In 6 of the above-mentioned cities the supply of milk used in 
infants' milk depots was certified by Medical Milk Commissions, and 
in practically all of the others it came from sources of undoubted 
purity. 

In IT of the 22 cities heard from the milk was modified under 
medical supervision to meet the special needs of infants. 

Pasteurization was practiced in 13 cities for a portion or all of 
the milk distributed, the temperature used varying from 150° F. to 
180° F., and the length of exposure being from ten minutes to thirty 
minutes. In the other cities pasteurization was not practiced, al- 
though in Detroit it was done in special cases upon the prescriptions 
of physicians. 

In Rochester the central milk depot, which was in charge of a 
trained nurse, was located at the farm, and the herd was tuberculin 
tested — conditions which should insure the production of pure raw 
milk. 

The extent of the movement may in a measure be estimated by the 
number of depots in operation and the quantities of milk distributed. 
The latter, if expressed in the number of bottles delivered, would 
mount well into the millions. 

It is the consensus of opinion of those interested in this work that 
the results have been exceedingly beneficial, although it is not possi- 
ble, except in one or two instances, to demonstrate by accurate sta- 
tistics the reduction in infant mortality. This lack of demonstration 
is largely due to the fact that the milk was used by a very limited 
number of the infant population, and to the impossibility of exclud- 
ing other factors, such as environment, climatic conditions, etc., re- 
sponsible for increased morbidity and mortality. Nor is it necessary 
to express in numerical terms the value of such institutions. Their 
educational value alone is sufficient to justify their existence — an 
influence that has extended both to the consumer and to the sub- 
scriber to the milk fund. Mothers have been taught the importance 
of nursing their infants, and when this was clearly impossible the 



635 - 

method and requirements necessary for the successful use of artificial 
foods. 

Through the cooperation of municipal authorities, the medical 
profession, trained nurses' associations, and others, instruction has 
also been carried to the homes of infants, with lasting benefit. 

There is great necessity for a wider extension of this movement, in 
order that its benefits may be felt in every congested center of popu- 
lation in the United States. In many of these areas the insanitary 
conditions surrounding the lives of infants are a menace to the State. 
Diffusion of knowledge with respect to all that pertains to infant 
hygiene is therefore demanded. 

Mothers should be encouraged in every possible way to nurse their 
infants, regardless of financial or social status. 

When breast feeding is clearly impossible, a pure supply of cow's 
milk, modified to meet the special needs of the infant, should be ren- 
dered available for both rich and poor. At the same time mothers 
should be instructed regarding the special requirements necessary 
to successful artificial feeding, including the care and administration 
of milk in the home. 

Private philanthropy has led the way. The public, through its 
official representatives, should assume its share of responsibility, both 
because of economic and sanitary considerations, and provide infants' 
milk depots for improving the physical well-being of the children 
who are destined to become the active producing members of the com- 
munity of the future. 



21. PASTEURIZATION. 



(637) 



PASTEURIZATION. 



By Milton J. Rosenau, 

Surgeon and Director Hygienic Laboratory, Public Health and Marine-Hospital 
Service, Washington, D. C. 



Pasteurization as applied to milk consists in heating it for a short 
period of time at a temperature below the boiling point, followed by 
rapid chilling. As we now understand it, the object is not so much 
to preserve the milk as it is to destroy the harmful bacteria and their 
products. 

Pasteur in 1860-1864 studied the " diseases " of wine, and found 
that it was sufficient to heat wine for a few moments at a temperature 
of from 50° to 60° C. in order to prevent souring and abnormal fer- 
mentation. In 1868 the successful experiment was made of sending a 
cargo of heated wine around the world upon the frigate La Syhile. 

Following the Franco-Prussian war, Pasteur studied the " dis- 
eases " of beer, and found that beer could be preserved by being sub- 
jected to a temperature of from 50° to 55° C. The application of this 
process gave rise to the new term " Pasteurization," which soon be- 
came current in technical language. 

It was not until 1886 that the distinguished chemist Soxhlet ad- 
vised the heating of milk for infant feeding and described an appa- 
ratus for carrying out the process in the home. To Soxhlet will ever 
remain the merit of having systematized and popularized the heating 
of milk for the special use of infants. 

In addition to heating the milk, Soxhlet divided the day's quantity 
conveniently into nursing bottles, which he had caused to be so shaped 
and arranged as to be readily cleansed and sterilized, upon the im- 
portance of all of which he properly laid stress. 

Soxhlet made the mistake of regarding milk, heated for a brief 
period at about the temperature of boiling water, as sterilized. He 
also placed undue stress upon a special stopper that hermetically and 
automatically sealed the flasks in cooling. 

In America, the Archives of Pediatrics contains no reference to 
the sterilization of milk until 1888. In 1889 Jacobi, who had long 
practiced and taught the wisdom of boiling milk for infant feeding, 
makes reference to the use of Soxhlet's apparatus. 

«Arch. Pediat, N. Y., 1889, 1517. 
(639) 



640 

It was soon pointed out by bacteriologists that Soxhlet's process 
was not sufficient to sterilize the milk, and that the remaining organ- 
isms grew and, according to Fliigge, were capable of producing 
harmful results. 

Further, it was found that the heating of milk for prolonged pe- 
riods or at high temperatures was neither necessary nor desirable ; 
and recourse was then had to the pasteurization process. As will be 
shown later, the confusion between " sterilized " and " pasteurized " 
milk has been largely instrumental in throwing discredit upon the 
latter process. 

Harm has also been done by the misleading use of the term "pasteu- 
rized milk," which has popularly been construed to mean a superior 
quality of milk, in the same sense that antiseptic surgery is a great 
advance upon the old time methods. " Pasteurized milk " really 
means heated milk, and is not necessarily synonymous with " clean 
milk," " good milk," or " pure milk." The particular object of the 
heating is to destroy the harmful bacteria. In order to correct this 
misconception concerning " pasteurized milk," it would be better to 
discontinue the use of the term and use in its place " heated milk," 
stating the degree of heat and the time of exposure on each bottle, as 
well as the date on which the milk was heated. 

Pasteurization does not mean simply the heating of milk ; the sub- 
sequent rapid cooling is a very important part of the process. 

If heated milk is cooled slowly it remains at a temperature be- 
tween 20° and 37° C. for a long time. This is the best temperature 
for the development of bacteria and their toxic products, and it 
requires only a few hours under such conditions to produce an 
enormous growth. 

Pasteurized milk must be handled at least as carefully as raw milk, 
if not more so. Pathogenic bacteria grow more readily in heated 
than in raw milk. The " germicidal " properties of the milk are 
destroyed by high heating, and finally the surviving bacteria do 
not have so hard a struggle for existence in the heated milk. It 
must not be forgotten that pasteurization kills only the major por- 
tion of the nonspore-bearing bacteria, and that a large number of 
micro-organisms remain and, if permitted to grow and multiply, they 
may occasionally produce undesirable qualities or perhaps poisonous 
properties in the milk. 

It must be quite evident to anyone who gives the matter thoughtful 
attention that the heating of milk, like the use of antiseptics, is an 
expedient rather than an ideal procedure. "Antisepsis " was a great 
improvement in surgery, but " asepsis," or the absence of germs, is the 
ideal. In the same sense, heating improves bacteria-laden and dirty 
milk, but clean milk is the end we must seek. " Pure milk is better 
than purified milk." 



641 

Milk presents the strange contradiction of being the most whole- 
some single foodstuff, and sometimes one of the most poisonous of all 
foods. A single feeding of a few gills of milk containing pathogenic 
bacteria or the toxic products of bacterial activity frequently results 
in sickness and death. Milk sometimes contains such violent poisons 
as to cause death in a few hours. Ordinarily, milk contains very 
many bacteria ; in fact, milk containing less than 10,000 bacteria per 
cubic centimeter is considered of excellent quality, and milk con- 
taining 100,000 bacteria per cubic centimeter is generally considered 
good. 

Of all foodstuffs, milk is the most difficult to preserve pure and 
handle with success. It requires not only intelligence, but a high 
degree of technical training, as well as incessant vigilance, to produce 
a clean and safe milk. Many believe that this end may be accom- 
plished by official supervision and a good system of inspection. 
However, we can scarcely conceive of any system of surveillance of 
the milk supply that will prevent its occasional contamination. In 
fact, the highest grade of certified milk has at times been accused of 
causing outbreaks of disease. Such lapses are infrequent and the 
danger slight. These facts are stated not as an argument that certi- 
fied milk should be pasteurized, but simply to show the difficulties of 
obtaining a safe raw product. 

Preventive measures are better than corrective ones. Pasteuriza- 
tion can not atone for filth. Milk should be produced under clean 
conditions and kept clean and it would not then have to be purified. 
But we must guard against enemies as long as they exist. We would 
all like to do away with the necessity for armies and navies, but pres- 
ent conditions demand their maintenance. The same is true of harm- 
ful bacteria in milk; so long as the average market milk is apt to 
contain these insidious foes, the only protection we have is to destroy 
them with heat. 

There can be no more objection to the heating of milk for the use 
of adults and of children above the age of 3 years than there is to the 
cooking of meat. Even Fltigge, who was one of the first to sound 
the warning that heated milk may subsequently develop poisonous 
properties for infants, has no objection to the heating of milk for the 
use of adults and of children above the age of 3 years. 

The question naturally arises, Is the danger from the use of the 
average raw market milk a serious one? Our investigations 6 in 
Washington have shown that the general market milk is, for the 

° Fliigge : Die Aufgaben und Leistungen der Milchsterilisirung gegeniiber den 
Darmkrankheiten der Sauglinge. Zeit. f. Hyg., vol. 17, 1894, p. 272. 

6 Rosenau, Lumsden, and Kastle, Bulls. 35 and 44, Hyg. Lab., U. S. Pub. 
Health and Mar. Hosp. Serv., Wash., 361 pp. 

45276°— Bull. 56—12 41 



642 

most part, old, stale, and dirty (in 1907 the milk averaged over 
22,000,000 bacteria per cubic centimeter and in 1908 over 11,000,000), 
and further, that at least 11.3 per cent of the cases of typhoid fever 
which occurred during the summer of 1906 in Washington were cer- 
tainly attributable to contaminated milk. In 1907 9.18 per cent 
and in 1908 about 10 per cent of the typhoid cases were traced to in- 
fected milk. Similar conditions have been found in other cities 
wherever the matter has been investigated. In addition to typhoid 
fever, the milk frequently conveys the infection of tuberculosis, 
scarlet fever, diphtheria, diarrhoeal and other diseases. One needs 
only to refer to other parts of this bulletin to assure himself of the 
extent to which death and disease are caused by impure milk. That 
phase of the subject therefore needs no further emphasis here. 

The average commercial milk of large cities is not a safe food. 
The principal reasons for this are the ignorance and indifference of 
those engaged in the dairy business, filthy barns, unclean and un- 
healthy cows, improper care of containers, insufficient cooling of the 
milk, long transportation, unnecessary and frequent handling, im- 
perfect cleaning and lack of sterilization of the bottles, and the fre- 
quent close association with contagious disease. 

The difficulty of obtaining a clean fresh milk supply is soon 
appreciated when we investigate the subject in any large city. For 
instance, in Washington the milk supply comes from over 1,000 
different dairy farms, situated in the surrounding counties of Vir- 
ginia and Maryland. Some of the cream comes from distant points 
in Pennsylvania and New York. Boston gets a large part of its 
milk supply from distances of 40 to 100 miles. The milk supply 
of the city of New York is produced at 35,000 farms scattered over 
5 different States, passes through 400 creameries, and comes over 
12 different lines of transportation. Some of the milk, at certain 
seasons, reaches New York from Canada, and shipments of cream 
arrive daily from Ohio. One hundred and fifty wholesale dealers 
are engaged in the business and the retail stores number 12,000, the 
daily consumption being 1,500,000 quarts. From this extreme case 
we will find every grade of complexity down to the small village 
and the individual farmhouse where fresh milk may be obtained 
twice daily. In New York only 16,000 quarts of the total of 
1,500,000 quarts daily used are " certified " as clean milk. 

THE EXTENT OF PASTEURIZATION. 

Freeman tells that it was about 1892 that the sterilization of the 
milk in the tenements of New York was widely adopted. So general 
has this become that the inspectors of the Rockefeller Institute for 
Medical Research, when recently seeking statistics concerning the 



643 

effect of different sorts of food on the health of babies in the tene- 
ments, were able to find scarcely any infants that were fed on raw 
milk. 

It is now estimated that about 25 per cent of the total daily milk 
supplied to the city of New York is pasteurized. 

About 123,250 of the total of 368,489 quarts of milk which come to 
Boston daily are subjected to commercial pasteurization. 

Pasteurization in bulk is practiced on a large scale in the cream- 
eries of Europe, particularly in Denmark and Germany. In Ber- 
lin and Copenhagen, especially, commercially pasteurized milk is in 
general use. In Denmark, in fact, paragraph 6 of the law of March 
26, 1898, relating to measures for combating tuberculosis in cattle 
and hogs, requires that all skimmed and bottled milk from Danish 
dairies to be used for feeding animals must first be heated to 85° C. 
This law, which went into effect June 1, 1899, was revised in 1903, 
and again on February 5, 1904, by requiring the products to be 
heated to 80° C. and adding to the products requiring pasteurization, 
cream used for the manufacture of export butter. Paragraph 7 of 
the same law requires that only such milk and buttermilk may be 
brought into Denmark as has been heated to at least 80° C. The 
Minister of Agriculture is, however, permitted to make certain ex- 
ceptions. 

In France the heating of milk is practiced by the wholesale dealers 
who supply Paris. A portion of the milk sold in certain of the larger 
cities of France and' of the milk distributed from the milk depots 
("gouttes de lait") is also first heated. Much of the cream destined 
for Paris is pasteurized. 

LAWS AND REGULATIONS CONCERNING PASTEURIZATION. 

Recently the State of Massachusetts and the cities of New York 
and Chicago have adopted measures relating to the pasteurization 
of milk and milk products. 

Massachusetts. — There are no regulations of the health department 
of the city of Boston covering the pasteurizing of milk and milk 
products, but in the year 1908 a State law was adopted. Jordan 
considers the measure an inoperative one because of the high tempera- 
ture specified therein. The Massachusetts State act follows : 

a Adolf Reitz, Milchhygiene u. Tuberkulosebekampf ung in Danemark u. 
Schweden, Zugleich ein Beitrag zur Technik Pasteurisierapparate. Zeit. f. 
Fleisch- u. Milchhygiene, 1905-6, 16, p. 143. 



644 

Acts of 1908, Chapter 570. 
heated milk. 

Section 1. Whoever, himself or by his servant or agent, or as the servant 
or agent of any person, firm, or corporation, sells, exchanges, or delivers, or 
has in his custody or possession with intent to sell, exchange, or deliver any 
milk which has been subjected to artificial heat greater than one hundred and 
sixty-seven degrees Fahrenheit, not having the words " heated milk " distinctly 
marked upon a light ground in plain black uncondensed gothic letters at least 
one inch in length, in a conspicuous place upon every vessel, can, or package 
from or in which such milk is, or is intended to be, sold, exchanged, or delivered 
shall for a first offense be punished by a fine of not less than fifty nor more than 
two hundred dollars, for a second offense by a fine of not less than one hundred 
nor more than three hundred dollars, and for a subsequent offense by a fine of 
fifty dollars and by imprisonment for not less than sixty nor more than ninety 
days. If such vessel, can, or package is of the capacity of not more than two 
quarts, said words may be placed upon a detachable label or tag attached 
thereto, and said letters may be less than one inch in length, but not smaller 
than brevier gothic capital letters. 

Sec. 2. Nothing in this act shall be construed as applying to condensed milk, 
or to milk which has been concentrated to one-half its volume or less. 

Chicago. — The following rules, regulating the pasteurization of 
milk and milk products, have been adopted by Dr. W. A. Evans, 
commissioner of health of the city of Chicago : 

RULES REGULATING THE PASTEURIZING OF MILK AND MILK PRODUCTS. 

The following rules shall regulate the pasteurizing of milk and milk products 
offered for sale, exposed for sale, or kept with the intention of selling within 
the city of Chicago, after January 1, A. D. 1909: 

Rule 1. Milk and skimmed milk. — Milk and skimmed milk shall not con- 
tain more than 100,000 bacteria per cubic centimeter from May 1 to Septem- 
ber 30, and not over 50,000 bacteria per cubic centimeter between October 1 
and April 30. 

Rule 2. Cream and ice cream. — Cream and ice cream shall not contain more 
than 200,000 bacteria per cubic centimeter from May 1 to September 30, and 
not over 100,000 bacteria per cubic centimeter between October 1 and April 30. 

Rule 3. Milk, skimmed milk, buttermilk, cream, and ice cream. — An origi- 
nal package of pasteurized milk, skimmed milk, buttermilk, cream, or ice 
cream, exposed to the temperature of the room for forty-eight hours and 
stoppered with a sterile cotton plug, shall not show evidences of putrefaction, 
after being so exposed. 

Rule 4. Skimmed milk and ice cream. — Skimmed milk and ice cream shall 
give a negative test when treated in the following manner : 

To 5 c. c. of the pasteurized product add two drops of a 2 per cent solution 
of paraphenylenediamin, and one drop of a 2 per cent solution of hydrogen 
peroxide, and agitate. Not more than a tinge of blue shall be obtained by this 
test within thirty seconds after mixing. 

Rule 5. Butter.— Butter shall respond to the following test: 

Twenty-five grams of pasteurized butter placed in a small beaker and heated 
by being placed in water at 60° C, the clear butter fat then poured off and 
the remaining liquid then diluted with an equal volume of water. The mixture 



645 

thus obtained is now treated with two drops of a 2 per cent solution of para- 
phenylenediamin and one drop of a solution of 2 per cent hydrogen peroxide. 
When thus treated not more than a perceptible blue color shall be obtained 
within thirty seconds after mixing. 

Rule 6. Pasteurizing temperatures. — All pasteurized milk, cream, skimmed 
milk, milk products, and milk and cream used in the production of milk prod- 
ucts shall be pasteurized in accordance with the following regulations: 

(A) Continuous pasteurization : In all continuous pasteurization the milk and 
cream shall be heated to a temperature which shall be determined and fixed by 
the department of health for each machine at a point corresponding to the 
temperature required to kill 99 per cent of the bacteria and all pathogenic 
bacteria contained in the raw product. For this determination ordinary raw 
milk containing in the neighborhood of 3,000,000 bacteria shall be used and the 
pasteurized product shall be collected as it flows from the cooling apparatus. 

All continuous pasteurizers shall be equipped with a feeding pipe which 
is so constructed that the pasteurizer can not be fed in excess of its normal 
working capacity ; that is, in excess of the working capacity of the machine at 
which 99 per cent of the bacteria are killed when the required amount of heat 
is applied. 

All continuous pasteurizers operated outside of the city limits, for the produc- 
tion of pasteurized milk and milk products to be sold in the city of Chicago, 
shall be equipped with an apparatus regulating automatically the supply of 
steam and heat, so as to correspond with and produce the required temperature 
of the outflow of the pasteurized product. These automatic thermoregulators 
shall be accurate, and must be approved by the commissioner of health before 
being installed. 

A recording apparatus shall be installed upon all continuous pasteurizers 
operated within the city limits so as to record during operation the temperature 
of the pasteurized product as it flows from the heater. The thermometer of 
this recording apparatus must be accurate and kept emerged in the milk in such 
a way that it is not exposed to escaping steam or other heat, except the heated 
milk. 

The records made by this recording thermometer must be accurate and made 
in a chamber which is kept under lock and key in the control of the department 
of health. 

The automatic thermo regulating and recording apparatus may be combined 
into one instrument, and it is recommended that all pasteurizers be equipped 
with both appliances or the combination apparatus. 

(B) Held pasteurization: Whenever milk is held during pasteurization in 
such a manner that the process of pasteurizing is not a continuous one, namely, 
a continuous flow of milk through the heating or heat-retaining chamber, the 
process shall be designated as " Held pasteurization." Such methods of pas- 
teurization and pasteurization appliances or systems installed and used shall 
be examined and approved by the commissioner of health, or his duly appointed 
representatives, when all of the following requirements are fulfilled : 

1. When the pasteurized product shows that over 99 per cent of the bacteria 
and all pathogenic bacteria contained in the raw product have been destroyed. 

2. When the mechanism of the pasteurizer or pasteurizing system is such that 
the three important elements, namely, the temperature, time of exposure, and the 
quantity of milk exposed at one time, can be readily kept under control and ob- 
servation by the department of health. 

3. When the following conditions are complied with : 



646 

A uniform heating of 140° F. maintained for twenty minutes; 150° F. main- 
tained for fifteen minutes; 155° F. maintained for five minutes; 160° F. main- 
tained for one and one-half minutes ; 165° F. maintained for one minute. 

The time shall be calculated from the period that the entire quantity reaches 
the required temperature. 

Rule 7. Cooling temperatures. — The pasteurized product shall be cooled at 
once to a temperature of 45° F. or less. This cooling shall be so conducted 
that the pasteurized product is not exposed to the air or other contamination. 
This cooling apparatus shall be so constructed that it can be readily cleaned 
and sterilized. 

New York. — In the amendments of the sanitary code of the depart- 
ment of health of the city of New York additional regulations for 
the sale and care of milk were adopted April 22, 1908. Among the 
additions the following rules apply to pasteurization : 

PASTEURIZED. 

1. Pasteurization of milk must be carried out under a permit therefor issued 
by the board of health, in addition to the usual permit for milk required by 
section 56 of the sanitary code. 

2. The milk after pasteurization must be at once cooled and placed in ster- 
ilized containers and the containers sealed. 

3. All pasteurized milk must be delivered to the consumer in sealed containers 
which are plainly labeled " Pasteurized." The labels must also bear the date 
and hour when the pasteurization of the milk was completed, the degree of 
the heat employed, the length of time exposed to the heat, and the number of 
the pasteurization permit issued by the board of health. 

4. Pasteurized milk must be delivered to the consumer within twenty-four 
hours of the pasteurization. 

5. No milk shall be pasteurized a second time. 

CHANGES IN THE MILK PRODUCED BY HEATING. 

The changes produced in milk by heating depend upon the degree 
of heat and the length of exposure. The exposure of milk to a tem- 
perature of 60° C. for a short time does not appreciably affect its 
chemical and physical properties. The boiling of milk, however, 
produces pronounced changes. These changes consists mainly of the 
following : 

Decomposition of the proteins, and other complex nitrogenous 
derivatives ; diminution of the organic phosphorus ; increase of inor- 
ganic phosphorus ; precipitation of the calcium and magnesium salts 
and the greater part of the phosphates ; expulsion of the greater part 
of the carbon dioxide ; caramelization or burning of a certain portion 
of the milk sugar (lactose), causing the brownish color; partial dis- 
arrangement of the normal emulsion and coalescence of some of the 
fat globules; coagulation of the serum albumin, which begins at 75° C. 

The casein is rendered less easy of coagulation by rennin and is 
more slowly and imperfectly acted upon by pepsin and pancreatin. 
Boiling gives the milk a " cooked " taste. The cream does not rise 
well, if at all. 



647 

When the milk reaches about 60° C, a scum forms on the surface 
which consists of — 

Per cent. 

Fatty matter 45.42 

Casein and albuminoid 50. 86 

Ash__ 3,72 

Milk heated in closed vessels does not form a pellicle even when 
the temperature reaches 1*00° or 110° C. Milk heated in the open 
air, after cooling forms a pellicle on the surface which renews itself 
if it is removed. It seems that this pellicle is due mainly to the 
drying of the upper layer of the liquid. The cream probably does 
not rise well in heated milk, owing to the increase in the viscosity of 
the liquid in which it is emulsified. 

Heat kills the ferments in milk, a which according to some authors 
play a useful role in digestion and metabolism. We have no direct 
knowledge of the utility of these milk ferments. For the child to 
digest and assimilate cow's milk to advantage the complex albumi- 
nous substances must first be broken down by the processes of digestion 
into simpler products and again synthetized. In other words, cow 
proteins must be converted into human proteins. In this process fer- 
ments play an essential role. We know that the digestive tube con- 
tains ferments that dissolve and break up the complex proteins into 
simpler substances, but concerning the rearrangement of the molec- 
ular structure into the form best suited for assimilation we have 
little definite knowledge. While ferments play an active part in 
both the breaking down and the building up processes, it remains for 
future investigation to determine which particular ferments are help- 
ful in the latter process. It has been abundantly shown by laboratory 
work that the ferments in milk, or most of them, at least, can with- 
stand a temperature ranging from 60° to 65° C. for some time with- 
out material injury. Between 65° and 70° most of these are weakened 
in their activity, and between 70° to 80° all of them are destroyed, 
even after relatively short exposure. (Kastle.) 

Raw milk shows the peroxidase reaction, whereas milk which has 
been heated for one hour at 70° C, or for shorter intervals at higher 
temperatures, does not exhibit this reaction. In this connection 
Kastle and Porch have observed that on heating milk to 60° C. for 
20 minutes, the peroxidase reaction of many specimens of milk is not 
only not diminished but if anything somewhat intensified. 

«Hippius (Deut. med. Woch., vol. 27, 1901, p. 481, 502) states that the oxi- 
dizing ferments are able to withstand temperatures between 60° and 65° C. for 
a long time, but are destroyed after a short exposure to 76° C. The lipase, or 
fat-splitting ferment, withstands one hour's heating at 60° C, or 62° for a 
short time; is weakened at 63°, and destroyed at 64° C. The proteolytic fer- 
ment withstands one hour's heating at 60° or half an hour at 65° C. The amy- 
lase withstands one hour at 60° and is only destroyed at 75° C. (See also 
Kastle and Roberts's article, No. 10, p. 313, this bulletin.) 



648 

The heating of the milk produces a decomposition of the albumi- 
noid matter, manifesting itself by the production of a little hydrogen 
sulphid. This gas may also be produced by the action of micro- 
organisms. 

It is claimed that the heating of milk renders a part of the phos- 
phates insoluble, and that this change favors rachitis in children arti- 
ficially fed with it. On the other hand it appears to be the general 
opinion of physicians that rachitis is the result of defective alimenta- 
tion, due to causes other than the changes in heated milk. 

The heating of milk for half an hour at a temperature of 150° F. 
(65° C.) or over, has the effect of entirely preventing the rising of 
the cream or of delaying it very materially. In normal milk the 
larger proportion of the fat droplets agglutinate into tiny globules 
or masses. At a temperature of 65° C. or above, these clusters are 
broken down and the globules are more homogeneously distributed 
throughout the fluid. 

The cooked or scalded taste appears at about 70° C, and becomes 
more pronounced the higher the temperature. This is due perhaps to 
changes in the nitrogenous products in the milk. The loss of certain 
gases also alters the taste^ so that milk heated in closed vessels has a 
much less pronounced flavor than if heated in open vessels. 

Milk sometimes curdles in the process of pasteurization. This is 
due to the amount of acid and calcium salts which it contains. In 
order to avoid such accidents, Kastle advises that the only safe rule 
to follow is to determine the effect of heating on small samples of the 
milk, which it is proposed to pasteurize. 

It has been observed that cooked milk coagulates with rennin more 
slowly than raw milk. This effect is noted often at temperatures of 
80° to 90° C, but it has not been observed in milk heated to 60° for 
twenty minutes. The curd produced by rennin coagulation in cooked 
milk is softer, less tough, and more flocculent than that produced by 
rennin coagulation in raw milk. This is believed to be an advantage 
favoring the digestibility of heated milk. 

TEMPERATURE AND TIME OF HEATING. 

The two dominant factors that control the temperature and time 
at which the milk should be pasteurized are, (1) the thermal death 
points of pathogenic bacteria, and (2) the ferments in the milk. The 
first must be surely killed so as to eliminate this danger, and the sec- 
ond should not be affected sufficiently to " devitalize " the milk. c 

« Reference to the article upon " The germicidal property of milk," Rosenau 
and McCoy, p. 455, shows that a temperature of 60° for twenty minutes but 
slightly affects this property of fresh raw milk. In old milk the so-called 
' ; germicidal action " disappears spontaneously. 



649 

So far as we are able to judge from our present knowledge the best 
temperature is 60° C. continued twenty minutes. A higher degree of 
heat for a shorter time is just as effective so far as the destruction of 
the bacteria is concerned. 

It may be confidently stated that the tubercle bacillus and the 
specific micro-organisms causing t}^phoid fever, diphtheria, dys- 
entery, cholera, etc., are rendered harmless by heating to 60° C. for 
twenty minutes. This opinion is based not only upon experimental 
data which have been obtained in the Hygienic Laboratory and re- 
cently published a but upon the experience and experiments of many 
others who have investigated this subject. It is fortunate that the 
thermal death points of the pathogenic bacteria that most concern us 
are below those of the ferments in milk, for in this way all infectious- 
ness may be destroyed without " devitalizing " the milk. 

So far as the true bacterial toxines are concerned, our knowledge is 
not so precise. We know that the true bacterial toxines are thermo- 
labile ; that is, readily affected by heat. Kitasato & showed that 65° C. 
and above is sufficient to destroy tetanus toxine in five miutes or less. 
It will sometimes withstand 60° C. for ten minutes, but is destroyed 
at 60° C. for twenty minutes. 

Diphtheria toxine is also rendered almost inert at about 60°, and 
botulism toxine is almost equally sensitive to heat. 

There is a group of bacterial poisons, however, which resists high 
temperatures. For instance, Marshal and Gallston found that heat- 
ing the cell substance of B. coli commune to 134° C. for fifteen min- 
utes did not appreciably lessen its toxicity. Cooley and Vaughan 
heated the same substance in a sealed tube to 164° C. without ren- 
dering it inert. Yaughan states further in his recent Shattuck lec- 
ture that many crude bacterial poisons withstand the boiling tem- 
perature. The nature of these poisons is not known. They are ob- 
tained by laboratory devices, and similar substances have never been 
found in market milk. 

It must further be observed that the poisonous properties of all 
these substances have mostly been determined by inoculation experi- 
ments and not by feeding. It can not be denied that milk may at 
times contain heat-resisting poisons, but their existence has been in- 
ferred, not demonstrated. Emphasis is placed upon this seemingly 
inconsequential point, for the reason that one of the principal objec- 
tions to pasteurization has always been that the heat does not neces- 
sarily destroy the poisonous products of bacterial activity. If such 
stable poisons are present in milk, and heat does not render them 

Hygienic Laboratory Bulletin 42, " The thermal death points of pathogenic 
micro-organisms in milk," by J. M. Rosenau, Washington, 1908. 

6 Kitasato, S. : Experimentelle Untersuchungen iiber das Tetanusgift. Zeit. f. 
Hyg., vol. 10, 1891, p. 267. 



650 



inert it is a limitation, not a disadvantage? of the process. If heat- 
resisting poisons are present in milk, the raw product will be quite as 
toxic as the heated, probably more so, for the heat may check the fur- 
ther production of such substances by its destructive action upon 
bacteria. 

At first, "sterilization" at or above the boiling point was attempted. 
It was soon shown that it was exceedingly difficult to sterilize milk 
on account of the resistant spores, and further, that a high degree of 
heat is not necessary. A more precise knowledge of the objects to be 
attained has gradually resulted in lowering the temperature and 
shortening the time. Temperatures varying from 95° to 60° C, and 
periods varying from a moment to two hours, have been variously 
recommended for the pasteurization of milk. As a rule the control- 
ling factor is the thermal death point of the tubercle bacillus. 

The temperature and time determined by various authorities for 
milk pasteurization follows: 



Authorities. 


Year. 


Tempera- 
ture (°C). 


Time 
(min- 
utes). 


Freeman a 


1898 
1907 
1892 
1899 
1899 
1905 
1890 
1900 
1900 


68 
60 
70 
60 
70 
60 
68-69 
60 
60 


30 


Freeman & 


40 


Forster c 


5-10 


Smith, Th.d 


20 


Oppenheimer < 


30 


Hippius / 


60 


Bitter g 


30 


Hesse h 


15-20 


Russell & Hastings *' 


20 







"Freeman, Arch. Pediat, N. Y. (1898), v. 15, p. 514. 

6 Freeman, Jour. A. Med. Assn., Vol. XLIX, Nov. 23, 1907, 21, p. 1740. 

"Forster, Hyg. Rundschau, Berl. (1892), v. 2 (20), 15. Okt, p. 872. 

a Smith, Th., J. Exper. Med., N. Y. (1899), v. 4, p. 233. 

e Oppenheimer, Munch, med. Wchnschr. (1899), v. 46, p. 1462. 

/■Hippius, Jahrb. f. Kinderh. (1905), v. 61, pp. 365-384. 

o Bitter, Ztschr. f. Hyg., Leipz. (1890), v. 8, p. 255. 

A Hesse, Ztschr. f. Hyg., Leipz. (1900), v. 34, p. 347. 

* Russell and Hastings, 17 Ann. Rep., Agric. Exper. St., Univ. Wis. (1900), p. 170. 

In view of certain differences of opinion concerning the tempera- 
ture and time of milk pasteurization, the definition still lacks com- 
pleteness. Therefore the misconceptions and confusions concerning 
the use of the term " pasteurized milk " have added to the prejudice 
against the process. We should protest against a word which means 
a generality and again insist upon all pasteurized milk being prop- 
erly labeled with the degree of heat, the period of time, and also with 
the date on which it was subjected to the process. 

So far as we may conclude from the evidence at hand, the heating 
of milk to 60° C. for twenty minutes destroys pathogenic micro- 
organisms without injuriously affecting its composition or quality and 



651 

without sensibly hurting its food value. We have authority for the 
statement that milk pasteurized at 60° C. for twenty minutes is 
" live " milk, rich in zymogens, and that such milk retains entirely the 
taste of fresh milk and is quite as digestible. 

THE BACTERIA AND TOXINS CONCERNED. 

Despite the great amount of work done upon this subject, there is a 
diversity of opinion as to which particular varieties of bacteria 
and their varied products are responsible for the large group of dis- 
eases comprised under the term " gastro-intestinal infections." There 
can be no doubt that there is a direct relation between the bacteria 
and their products in milk and the bowel complaints of children. 
It is also clear that these are not all acute specific diseases due to 
one cause. The factors are complex. It is not only the bacteria and 
their poisons in the milk, but also the bacteria always contained 
in the gastro-intestinal canal, that play an important part. While 
it is undoubtedly true that milk sows the seed and often actually 
contains the poison, it is also well known that a deranged digestion, 
which favors abnormal fermentation and putrefaction of the milk 
within the body, resulting in the class of affections known as " auto- 
infections " and " auto-intoxications," here plays a definite role. All 
clinicians agree that the first essential for the successful treatment 
of the gastro-intestinal diseases of children is to at once discontinue 
the use of milk. The great prevalence of this class of diseases in the 
heated months of summer makes it perfectly plain that the depress- 
ing influences of heat seriously affect the resistance of the infant. 
At the same time the heat favors the growth and multiplication of the 
bacteria in the milk. 

Children vary much in their susceptibility to the bacteria and the 
bacterial products concerned. The same milk may act as a violent 
poison to one child while another living under the same conditions 
may escape. 

Fliigge a laid particular distress upon the peptonizing bacteria 
which for the most part are spore-bearing organisms. The spores 
survive the heat of pasteurization and have a free field for growth 
and activity. As a rule the organisms known as the lactic acid group 
gain the ascendancy in raw milk, and these bacteria have a restrain- 
ing effect upon the great majority of other species. Fliigge found 3 
of the 12 peptonizing bacteria isolated by him from heated milk to 
have poisonous properties. Pure cultures in milk, when injected into 
laboratory animals, cause severe symptoms, and in one instance when 
fed to a puppy produced fatal diarrhea. 

° Fliigge, C. : Die Aufgaben und Leistungen der Milch- Sterilisirung gegeniiber 
den Darmkrankheiten der Saulinge. Zeit. f. Hyg., vol. 17, 1894, p. 272. 



652 

In a recent article Colwell and Sherman a point out that the pas- 
teurization of milk at 60° C. appears to restrain peptonization to 
about the same extent that it restrains souring. It apparently has no 
constant effect in rendering the milk either more or less liable than 
raw milk to the development of offensive odors. 

Following Fliigge, attention was focused upon the peptonizing 
action of bacteria. The evidence is contradictory, but for the most 
part, Flugge's contentions have not been confirmed. Eecent investi- 
gations show that the cleavage of proteids by bacteria is much more 
like that caused by the digestive juices than has heretofore been sup- 
posed. There is little evidence for the view that poisonous substances 
can be formed by the direct cleavage of proteids by bacteria ; in fact, 
the two best known of the bacterial poisons (diphtheria and tetanus 
toxines) can be produced in proteid-free media. 

The bacterial toxines. — Much has been written upon " toxines " in 
milk. However, when we sift the matter down we find that we know 
practically nothing of the true bacterial toxines concerned. 

Toxines are soluable chemical substances of unknown composition 
that produce poisonous symptoms after a definite period of incuba- 
tion and are capable of inducing immunity as a result of the produc- 
tion of antibodies. 

We are acquainted with very few bacterial toxines. The best 
examples are tetanus, diphtheria, and the toxine produced by the 
Bacillus botulismus. These toxines are not resistant to heat; they 
are all rendered practically inert at a temperature of 60° C. 

Bacterial toxines are not the result of proteolytic action upon the 
albumins contained in the media in which they grow. They may be 
secreted by, or result from, the breaking down of proteids of the 
bacterial cell. Concerning their mode of production and their chem- 
ical nature we have no definite knowledge. 

None of the true toxines are poisonous when taken by the mouth 
except the botulism toxine. For instance, the strongest one known 
(tetanus) is harmless when taken by the mouth. & We have given a 
guinea pig 24,000 and a mouse 8,000 minimal lethal doses by the 
mouth without appreciable effect. It is, therefore, plain that the 
effects of a toxic substance found in milk when injected into labora- 
tory animals is no criterion of its effect when taken by the mouth. 

Particular attention is drawn to this fact because much of the ex- 
perimental work upon the poisonous substances in milk has been done 
by injecting these substances into the tissues of lower animals. It is 
now plain that violent poisons, when introduced subcutaneously, may 
be inert when taken by the mouth. We must also be cautious in 

° Colwell, R. H., and Sherman, H. C. : " Chemical evidence of peptonization in 
raw and pasteurized milk." Journ. Biolog. Chem., Oct., 1908. 
6 Snake venom is also harmless by the mouth. 



653 

interpreting feeding experiments upon lower animals as applied to 
man, especially when we consider the great differences in suscepti- 
bility of the gastro-intestinal tracts of different species. This differ- 
ence is marked even among infants, for it is known that not all per- 
sons taking poisonous milk suffer equally, and some escape altogether. 

The " endotoxines " and bacterial proteids are substances which are 
more or less firmly retained by the living bacterial cells. The poison- 
ous action of these so-called " toxines " is closely associated with the 
phenomenon of anaphylaxis. We are not yet sufficiently well ac- 
quainted with the composition and mode of action of this important 
class of poisons to formulate their relation to milk. 

The colon group. — The type of this large group of bacteria was 
first described by Escherich as Bacillus coli commune. While the 
colon bacillus is undoubtedly the cause of certain pyogenic and septi- 
cemic conditions, its power to produce harm in milk is uncertain. 
Normally it is practically always present in the lower intestines of 
mammalian animals, where it doubtless serves a useful purpose per- 
haps by keeping harmful varieties in check. 6 

The colon bacillus was at one time regarded as the common cause 
of various diarrheal infections, but it has now been differentiated into 
the dysentery bacillus, the typhoid bacillus, and other closely allied 
species. Even now it is difficult to disassociate its action from that of 
its closely allied cousin, the B. lacticus aerogenes. These two organ- 
isms sometimes induce excessive fermentation of lactose and other 
sugars with the production of irritating acids (especially acetic and 
lactic) and at the same time liberate an excessive amount of gas, 
thereby causing diarrhea. 

The typhoid bacillus. — It is known that this bacillus often con- 
taminates milk, which thus becomes the vehicle of some of the typhoid 
fever in large cities. The paratyphoid and paracolon organisms are 
closely allied and may doubtless be transmitted in like manner. The 
paratyphoid bacillus is a frequent cause of meat poisoning, but a 
similar action in milk has not been shown. 

a Rosenan, M. J., and Anderson, John F. : " A study of the cause of sudden 
death following the injection of horse serum." Bull. No. 29 Hyg. Lab., U. S. 
Pub. Health and Mar. Hosp. Serv., Washington, 1906. 

Rosenau, M. J., and Anderson, John F. : "Further studies upon hypersuscepti- 
bility and immunity." Bull. No. 36 Hyg. Lab., U. S. Pub. Health and Mar. 
Hosp. Serv., Washington, 1907. 

Also Hyg. Lab. Bulls. Nos. 45 and 50, upon the same subject. 

6 For a full discussion of intestinal bacteria and their products, see Herter's 
admirable book on the Common Bacterial Infections of the Digestive Tract and 
the Intoxications Arising from Them, 360 pages. New York, 1907. 



654 

The dysentery bacillus. — Shiga, who discovered this organism, now 
recognizes 5 types, based on fermentative changes. This organism, 
like the typhoid bacillus, is " hemiparasitic " in the sense used by 
Herter; that is, it produces disease only when the bacilli have been 
introduced in considerable numbers or have had an opportunity to 
multiply owing to the feeble powers of resistance on the part of the 
infected individual. 

It seems that the nearer the various varieties of dysentery and 
typhoid bacilli approach the colon bacillus the less virulent they 
become. 

The dysentery bacillus has only been known since 1898 and its rela- 
tion to milk is not well worked out, but there can be little doubt that 
milk may by a means of spreading infection by this organism. 

The Bacillus proteus or proteus vulgaris. — This is a common organ- 
ism found frequently in normal feces in moderate numbers and com- 
monly contaminates milk. This bacillus produces the tryptic fer- 
ment that peptonizes casein and it also attacks carbohydrates. That 
this organism may induce acute diseases of the gastrointestinal tract 
appears to be well established. 

The tubercle bacillus. — Tubercle bacilli have frequently been found 
in milk, and their relation to disease is discussed elsewhere. 

KocKs cholera bacillus. — The specific cause of cholera requires an 
alkaline medium in which to grow. As milk is usually acid or soon 
becomes acid, the cholera vibrio has little chance of survival, though 
small outbreaks of cholera have been traced to milk. 

The Micrococcus melitensis. — This organism causes Malta fever 
and is found in goats' milk. It is fully discussed elsewhere in this 
bulletin. 

The Bacillus diphtheria. — The diphtheria bacillus finds favorable 
conditions for growth and multiplication in milk. A number of out- 
breaks of diphtheria have been traced to milk so contaminated. 

Streptococci and Staphylococci. — These form an exceedingly impor- 
tant group of organisms on account of their frequent and exceptional 
virulence. They are almost constantly found in milk, frequently in 
great numbers. Herter says that the human intestinal tract under 
normal conditions is probably most ol the time free from pathogenic 
varieties of this group of cocci. 

In healthy adults these pathogenic bacteria introduced with milk 
are ordinarily quickly destroyed in the upper portion of the tract. 
During infancy the digestive tract is very much less resistant to 
streptococcic infection. An invasion of the mucous membrane by 
streptococci is of frequent occurrence and may be associated with 
disturbances of almost any grade of severity. 

It has been shown by Bucher in this country, and by Escherich of 
Germany, that some of the severest forms of infantile ileo-colitis are 



655 

associated with streptococcic infections and are probably dependent 
upon them. 

The Streptococcus lactis, first described by Kruse, has been proved 
by Heinemann in this country to be one of the common causes of 
lactic acid fermentation in milk. It appears to be indistinguishable 
from the pathogenic forms and is always present in market milk. 

The anaerobic spore-bearing micro-organisms. — Fliigge first 
pointed out the importance of the anaerobic spore-bearing organisms 
in milk and their relation to infantile diarrheas. He especially 
singled out thei?. butyricus (Botkin). It now appears that Botkin's 
bacillus represents two distinct micro-organisms. Herter considers 
that the B. putrificus and the B. aerogenes capsulatus, which grow in 
milk, play an important role in intestinal putrefaction. The B. 
aerogenes capsulatus^ for instance, produces poisons belonging to 
the hemolytic and proteolytic class. According to Kamen, a it also 
forms soluble poisons obtainable by filtration. Kamen likens this 
poison to " sepsin," in that it acts as a respiratory poison and induces 
vomiting, diarrhea, tenesmus, and death. This poison is not de- 
stroyed by heating to 60° for fifteen minutes. 

In addition to the bacteria and the bacterial products above con- 
sidered, the products of fermentation and putrefaction in milk have 
long been regarded as poisonous substances. Just which of these 
products are the chief culprits is far from being determined, although 
much work has been done upon the subject. The best known prod- 
ucts of fermentation and putrefaction are the following: 

Acids. — Milk frequently contains lactic, butyric, acetic, and other 
organic acids, which result from the common fermentative changes. 
The higher volatile fatty acids come especially from the spore-bear- 
ing anaerobes, and result from putrefactive decomposition in the 
milk. All these acids are irritants, by virtue of their acid properties. 
If present in considerable concentration in a healthy digestive tract 
or in a more moderate concentration in a person with an irritable 
stomach or with deranged digestion they may be factors in exciting 
vomiting or diarrhea. It is probable that when these acids produce 
acute symptoms they result more from fermentative processes within 
the gastro- intestinal tract rather than from those produced in milk 
before it is taken. 

The presence of excessive amounts of acids in the intestinal tract 
may indirectly produce chronic poisonous conditions by robbing the 
organism of alkali. 

Basic substances. — The true bacterial toxines were first thought by 
chemists to be basic substances resembling alkaloids. We now know 

° Kamen: Zur Etiologie der Gasphlegmone. Cent. f. Bakt, Orig., vol. 35, 
1904, pp. 555, 686. 



656 

that this is not the case. Many basic substances, some of them poi- 
sonous, have been described as ptomaines; but their relation to the 
poisonous properties of milk is very doubtful. Tyrotoxicon, one of 
the chief of these, studied by Vaughan, is now admitted to be rare in 
milk and cheese and its chemical composition undetermined. The 
ptomaines contain nitrogen and have generally been looked upon as 
products of decomposition of the proteid substances in milk. 

Cholin is a base which can readily be split off from the fatty body 
lecithin. Milk contains about one-tenth of 1 per cent of lecithin. 
While cholin itself is not very poisonous, Hunt has shown that acetyl- 
cholin is 100,000 times more toxic than cholin itself and that there are 
other poisonous cholin compounds. While acetylcholin has never 
been demonstrated in milk, theoretically it is possible to have a small . 
quantity of this and allied poisons formed. Lecithin may be decom- 
posed by bacterial action, and it is not unlikely that a similar action 
is responsible for poisonous bodies of this group. 

Sulphur compounds. — Sulphur compounds, such as hydrogen sul- 
phide, while poisonous, are not present in sufficient quantity in milk 
to give serious concern. 

Aromatic products, such as the phenols and cresols, skatol, indol, 
etc., result from the putrefaction of albumins of the common proteid 
foods. Milk yields considerable quantities of tyrosin from its casein. 
The phenols and cresols are derived from the breaking down of the 
tyrosin. ITerter thinks that the phenols can not be regarded as im- 
portant toxic agents; moreover, they are produced by putrefactive 
processes in the intestinal tract and are not contained in any quantity 
in milk when it is consumed. 

To sum up our knowledge, we find that certain bacteria contained 
in milk, such as tubercle, cholera, dysentery, typhoid, diphtheria, etc., 
may induce specific diseases. Other organisms, such as the virulent 
streptococci and staphylococci, are capable of causing sever inflam- 
mations of the gastrointestinal tract. The spore-bearing organisms 
set up putrefactive and proteolytic changes, and may produce poisons. 
This occurs in milk, both within and without the body. The nature 
of these poisons is not known. So far as we know, the true bacterial 
toxines play little if any role in milk poisoning. 

INFANT FEEDING. 

Prepare cow's milk as we may, we can not shut our eyes to the 
fact that it is out of the question to anticipate such good results from 
artificial feeding as from breast feeding. It is well known that the 
lowest death rate for the first year of life is shown among those in- 
fants who are fed on good human breast milk. 

It is the milk of other animals, usually the cow, which directly 
or indirectly kills the greatest number of infants. All are agreed that 



657 

if a child must be artificially fed it is best to use fresh, pure milk; 
but when we consider that thousands of infants in our large cities 
must depend upon the milk of a cow many miles away, we are con- 
fronted with a difficulty not readily overcome. Nature did not intend 
the young of one species to be raised upon the milk of another, much 
less did it intend that milk to be dirty, stale, and bacteria-laden. We 
have unanimous testimony that such milk, especially in the heated 
months of summer, is the cause directly or indirectly of the excessive 
infant morbidity and mortality. 

The average city market milk that has already deteriorated in 
quality can not be revivified. Xo known process will make bad milk 
good milk ; but further fermentation and putrefaction in the milk can 
be stopped, and pathogenic organisms killed, by heating it to 60° C. 
for twenty minutes. Bad milk, whether heated or unheated, is unfit 
for infant feeding, but if infants must depend upon old dirty and un- 
cared for milk it would be much better, especially in the summer 
months, to practice pasteurization, in spite of its alleged disad- 
vantages. 

The quantity of certified or clean milk in any community is but a 
drop in the bucket, and until health officers can assure a good quality 
of milk the only protection we have is the expedient of heating it. 

It is by no means claimed that heated milk is the ideal to be at- 
tained. On the contrary, we want, good, fresh milk that needs no 
heating. At present it is exceedingly difficult to obtain such milk 
in our large cities, and anyone who investigates the matter care- 
fully will soon convince himself that it will be many years before 
this is possible and only after a revolution of the milk industry. In 
the meantime we must protect ourselves. 

Physicians who have had large experience in the care and feeding 
of infants have a prejudice against the use of heated milk for pro- 
longed periods. While it is admitted that the use of heated milk 
greatly diminishes the amount and seriousness of infantile diar- 
rheas, it has been stated that while the children at first do well they 
may become flabby and anemic and the subjects of scurvy. It is 
probably not the heating but some other factor in the milk that 
induces scurvy. 

We have the published testimony of a large number of physicians 
to the effect that the use of pasteurized milk produces no harmful 
effects that may be attributed to the heating. But when all is said 
and done the pasteurization of milk for infant feeding can neither 
be recommended nor discountenanced as a general proposition. The 
saying that " one man's meat is another man's poison " applies with 
special significance to the artificial feeding of infants. The general 
pasteurization of all milk used for the nourishing of infants would 
45276°— Bull. 56—12 42 



658 

be as irrational as the general use of one formula. Each infant is 
a law unto itself, and whether it is to receive heated or unheated milk 
must depend entirely upon the conditions, especially the season of the 
year and the quality of the milk available. 

Scurvy. — Scurvy occurs in children fed both upon pasteurized and 
unpasteurized milk ; it may even occur in breast-fed infants. Scurvy 
is at most a comparatively rare disease. As there are countries where, 
despite sterilization, scurvy practically never occurs, the cooking of 
the milk can not be the only cause of this disease. It is not a new dis- 
ease, but was described in infants for the first time only a decade ago. 
Even at the present time the disease is often not recognized by clini- 
cians. Formerly the condition was called " acute ricketts " (Moeller) . 
In Germany we are told the disease is either exceedingly rare or not 
recognized. For a long time the French claimed that the disease did 
not exist among them, but during the past two or three years there 
have been occasional reports of isolated cases (Netter). 

The disease was first studied by English clinicians and we are es- 
pecially indebted to Barlow, who, after a study of 11 cases with post- 
mortem results of 2, showed the essential features of the disease and 
gave it the name of scurvy. It is often spoken of as Barlow's dis- 
ease, or the Moeller 6 -Barlow disease. 

We do not know whether scurvy has increased greatly during the 
past twenty years, or whether our more precise knowledge of the dis- 
ease has made this apparent. Those who believe the disease is in- 
creasing attribute this fact to the use of dried proprietary infant 
foods and the increasing use of heated milk. 

The proper treatment of infantile scurvy gives almost miraculous 
results. " Within a few hours a pitiable, suffering little paralytic 
is transformed to a contented baby waving its arms and legs in the 
sheer joy of living." This may be simply brought about by the use 
of fresh milk, fruit juices (orange, grape, or pineapple), beef juice, 
egg albumen, or puree of potato, according to the child's digestive 
capacity. Scurvy is thus not only readily preventable, but amenable 
to treatment, and it would seem that those who have to choose be- 
tween the use of badly contaminated milk, with its serious conse- 
quences, and the remote possibility of scurvy as a result of pasteuriza- 
tion, should not hesitate long in the choice. 

I have made a careful compilation from the literature of the re- 
sults of raising children upon heated milk, and find hundreds of in- 
stances recorded, especially by French observers, to the effect that 
children flourish well upon heated cow's milk and without the pro- 

° Barlow: Med. and Chir. Transactions, London. Vol. 66, p. 83. 
& Moeller: Akute Rachitis. Konigsberg. med. Jahrb., Bd. I (59), and Bd. 
Ill (62). 



659 

duction of scurvy. But in view of the fact that scurvy is either rare 
or not recognized in France we must examine these figures critically. 

Some of this evidence follows : 

Variot a in a recent communication sums up his experience with the 
use of heated milk for infant feeding as follows : 

At the dispensary of La Goutte de Lait de Belleville, which I have directed 
since 1892, we have distributed for twelve years in the poorest quarters of 
Paris about 400,000 bottles of sterilized milk to more than 3,000 infants of the 
working class deprived of their mother's milk. With my collaborateurs, MM. 
Drs. Dufestel, Lazard, and Roger, we have made a study of the artificial feed- 
ing with sterilized milk and the results of our experiments are so decisive, each 
case controlled by weight, and an examination of the organs and functions, that 
we think our results merit publication. 

The milk received from farmers in the country is heated to 108° C. before 
transportation in the bottles of half a liter, stoppered with cork and the medical 
seal. This milk keeps several days without alteration, even during the greatest 
heat of summer. It is delivered daily at the Belleville dispensarv to 100-150 
infants. Every week or oftener if necessary the infants are "weighed and 
inspected with care, records of which are kept. The following are some of the 
conclusions of the results of twelve years' experience : 

1. The milk sterilized at 108° C. preserves all of its nutritive value. It is 
not inferior to milk pasteurized at 80° C. or with heating at 100° C. in the appa- 
ratus of Soxhlet. 

2. The destruction by the heating of the enzymes, the slight alteration of the 
lactose, the doubtful precipitation of the citrate of calcium, or the alteration 
of the lecithins does not affect its assimilability in an appreciable manner. Not 
one case of infantile scurvy has been observed by the dispensary. 

3. Thanks to this sterilized milk we have been able to raise not only healthy 
infants, but also atrophic infants, retarded in their development as a result of 
gastro-intestinal troubles. 

4. Rachitis did not develop in any of the infants. 

5. In 3,000 infants of the poorest class about 3 or 4 per cent showed them- 
selves incapable of using sterilized milk. 

6. Constipation and anemia were not rare among the infants raised by this 
method. On the other hand the summer diarrheas were markedly attenuated 
in severity. 

Berlioz & reports favorable results from the use of sterilized milk. 
He believes that with such milk we are capable of enormously re- 
ducing infant mortality. From 1894 to 1897 he distributed sterilized 
milk to the poor of Grenoble during the months of July, August, and 
September. It was sterilized in an autoclave at 110° C. for half an 
hour in bottles containing 200-250 cubic centimeters. 

a Variot, M. G. : Valeur nutritive du lait de vache sterilise a 108° pour 
1 allaitement artificiel. Comp. rend, des seances de l'Acad. d. Sci vol 139 
1904, p. 1002. 

^ »Budin, M. P.: Sur le lait sterilise. Bull, de l'Acad. de med., 3 me ser., vol. 



660 



The use of this milk gave the following death rates : 



Year. 


(A.) 

Children 

fed on milk 

not sterilized 

(per 1,000). 


(B.) 
Children 
fed on steril- 
ized milk 
(per 1,000). 


1894 


66.8 
86.9 
54.0 


25.6 


1895 


42.2 


1896 


16.1 










69.3 


27.9 







The difference in favor of sterilized milk is much more striking 
than the figures indicate, for Class A includes bottle and breast-fed 
children, while Class B includes only bottle-fed children. Further, 
the first figures are compiled from children of the better class, while 
the latter are drawn from children of the poorer classes. 

Carel, a from observations upon infants of the working classes in 
Paris, recommends the use of sterlized milk from the time of wean- 
ing. He believes further that the use of sterilized milk has brought 
about a reduction in the dangers to infants to a minimum. In in- 
fants of normal weight and good health, nourished with sterilized 
milk, the dentition proceeds normally and the mortality from gastro- 
enteritis is nil. 

From a comparison of two series of observations of infants coming 
from families of the same social conditions, living in the same quarter, 
and of whom the mothers had received the same advice, there oc- 
curred 31.8 per cent of rachitis among those nourished with ordinary 
milk (210 observations). The proportion of rachitis in 373 infants 
who received sterilized milk was only 15 per cent. None of the 373 
infants given sterilized milk presented any symptoms of infantile 
scurvy (Barlow's disease). 

Budin and Chavane, & 1894, reported 15 successful cases in 1892 and 
1893 of infants fed upon milk sterilized at 100° C. in a water bath 
and used within twenty-four hours. They give in detail the increase 
in weight and the condition of each infant. 

Maygrier, c 1901, states that of 590 infants who received sterilized 
milk from 1878 to 1901 not one died of diarrhea. Much similar testi- 
mony to the same effect could be brought forward. 

While the evidence is clear that many children are successfully 
raised upon milk heated even above the boiling point, on the other 

° Carel, Armand : Le lait sterlise. Paris, theses, 1902-3. 

& Budin, P., and Chavane, A. : De l'emploi, pour les nourrissons, du lait ste- 
rilise a 100 degres au bain-marie. Bull, de Acad, med., 3 me ser., vol. 32, 1894, 
p. 67. 

c Maygrier : La consultation de nourrissons a la Charite, de 1898 a 1901. Ob- 
stetrique, vol. 6, 1901. 



661 

hand we have a number of cases of scurvy following the use of heated 
milk, the condition ceasing with the use of raw milk. Of the 379 
cases of scurvy brought together in the report of the American 
Pediatric Society in 1898, sterlized milk was the previous diet of 107. 

Every physician knows from observation that some children do 
very well upon cooked milk. It is also generally known that it is 
often only necessary to correct the general dietary, to prevent over- 
feeding, and to correct the formula, in order to convert an apparently 
bad milk which is not agreeing with an infant into a good food. 
Often at the same time the heating of the milk is discontinued and 
the good results of the change are credited to the use of raw milk. 

The results of animal experiments are somewhat contradictory 
and rather unsatisfactory. Observation upon infants, however, gives 
us definite results. Finkelstein, for instance, has shown that infants 
evidently do worse with cooked woman's milk than with raw milk. 
These experiments correspond entirely with similar experiments made 
with cow's milk upon calves. Finkelstein next made the experiment 
of feeding cooked and uncooked cow's milk to children. He used the 
best milk obtainable in Berlin, and was careful to use the same milk 
in both cases. The additions, dilutions, and other conditions were 
precisely the same. The only factor which varied was that in one 
instance the milk was cooked and the other raw. A study of these 
parallel cases does not show any essential difference so far as nutri- 
tion is concerned between those receiving the raw milk and those 
receiving the cooked milk. Finkelstein tells us that similar experi- 
ments made in Stockholm, but continued over a longer time, viz, 
three years, confirms his observations and failed to show any differ- 
ence between the two methods. 

So far as other metabolism experiments on infants are concerned 
they likewise practically all point to the conclusion that raw milk 
has no advantage over cooked milk. This is especially evident with 
respect to the organic constituents of milk. So far as the metabolism 
of the mineral substances is concerned the evidence is somewhat con- 
tradictory. Thus, Mueller and Cronheim found the calcium balance 
to favor raw milk. a These results have not been confirmed by the 
work of others. 

Krasnogorky found that iron is taken up more readily from cooked 
than from raw milk. 

So far as we are able to conclude from the evidence at hand upon 
metabolism experiments, raw milk certainly has no advantages over 
cooked milk. 

Finkelstein, H. : Die rone Milch in der Saulingsernahrung. Therap. 
Monatsh., vol. 21, October, 1907, p. 508. 



662 

When we consider that we know practically nothing of the essen- 
tial nature of scurvy we must be cautious in considering the con- 
nection between pasteurization and scurvy as cause and effect. 
Kotch, a for instance, says: 

In those cases where scorbutus has apparently occurred in infants who were 
being fed on milk heated to 212°, it may have been some other quality in the 
milk which produced the scorbutus, and that either the percentages which the 
infant has been fed upon are not those which are adapted to and fitted to that 
especial infant or that it is an exceedingly dirty milk which they have been 
boiling at 212°, and which necessarily does not become a sterile milk in the 
meaning of infecting the individual. 

The unsatisfactory state of our knowledge upon this subject is 
evident from the following views recently expressed : 

Rummell 6 doubts the relationship between the Mueller-Barlow's 
disease and sterilized milk. The cause of this disease, despite the 
great literature upon it, is entirely unknown. The fact that the 
occurrence of infantile scurvy varies so much in different regions 
leads one to suppose that perhaps it has some relation to the food of 
the cow rather than to the heating of the milk. That the disease 
seems to be brought about sometimes by high-grade sterilization of 
the milk, in an analogous way to scurvy in adults, seems probable. 
Animal experiments have been very contradictory and have not 
yet done much to clear up the situation. 

Koeppen c looks upon scurvy as an auto-intoxication brought 
about by intestinal putrefaction, which process is favored in children 
artificially raised. 

Recent evidence (see Schereschewsky's paper, article No. 23, in this 
bulletin, p. 687) points to the fact that scurvy may be brought about 
by lack of the vegetable inorganic salts of alkaline bases, especially 
potassium, in the infant's dietary. This, combined with the injurious 
effects of a high percentage of fat in the food, may bring about 
serious disturbances of digestion and metabolism, favoring the pro- 
duction of the scorbutic condition. If this view is correct it entirely 
eliminates the heating of the milk as an etiologic factor. 

The admirable work of Hoist and Frolich d (1907) goes far to 
clear up many of the doubts concerning the etiology of scurvy. These 
investigators have produced a disease in guinea pigs practically iden- 
tical with human scurvy. This was done with a one-sided diet con- 

a Rotch, Thomas Morgan : " The pasteurization of milk for public sale." Am. 
Journ. Pub. Hyg., vol. 17, May, 1907, p. 181. 

6 Rummell, O. : Sterilisierte Milch? Deut. Praxis, vol. 13, 1904, p. 201-207. 

c Koeppen : Zur Moeller-Barlow'schen Krankheit. Jahrb. f. Kinderheilk. Bd. 
44. 1897. 

d Hoist, A., and Frolich, T. : " Experimental studies relating to ship beriberi 
and scurvy," (II) "On the etiology of scurvy." Journ. Hyg., vol. 7, Oct., 1907, 
p. 634. 



663 

sisting of various sorts of grain, groats, and bread. The guinea pigs 
did not get the disease when fed upon a one-sided diet consisting of 
fresh cabbage or fresh potatoes, whereas it was produced by dry 
potatoes; that is, the disease originates in guinea pigs as well as in 
man as a result of a diet confined to some special nutriments. 

Hoist and Frolich also observed that the disease in guinea pigs is 
favorably influenced by different sorts of nutriments known from 
human experience as " antiscorbutics." They found, however, that at 
least one of their nutriments, viz, cabbage, loses a deal but not all of 
its preventive power when boiled for half an hour at 110° C. There 
is no evidence to show that moderate heating, such as is used in the 
pasteurization of milk, in any way affects the scorbutic or antiscor- 
butic qualities of a food. 

Infant mortality. — It is now well established that the large major- 
ity of infantile deaths is caused by gastro-intestinal diseases. Fur- 
ther, that this great fatality occurs especially among artificially 
raised infants, and finally that the vast majority of cases and deaths 
from bowel troubles in children occur during the heated term. The 
infant mortality in all countries is shockingly high. This is shown 
to be unnecessary by the fact that infants who are well cared for 
show a relatively low mortality. Defective feeding is the active 
cause of this high mortality, while heat, humidity, and bad surround- 
ings are contributary causes. It must be remembered that the normal 
intestinal mucous membranes are permeable to bacteria, and more so 
during the period of infantile than of later life. Hence one of the 
great dangers of using bacteria-laden milk. While the factors in- 
volved in this " slaughter of the innocents " are numerous, primarily 
or secondarily they depend upon the activity of micro-organisms. 
Freeman believes that the decline in the infant mortality in the 
United States during the last ten years, and especially in New York 
City, is due for the most part to the decline in mortality from sum- 
mer diarrhea, and states " that the general adoption of pasteurized 
and sterilized milk for infant feeding is by far the most important 
agency." A definite example of the diminution in mortality from 
pasteurizing the milk occurred in the infants' hospital at Randalls 
Island, where the mortality in 1897, with raw milk, was 44.36 per 
cent, while in 1898, with pasteurization of the milk, it was 19.80 per 
cent. 

Numerous similar instances of the beneficial effect upon infant 
mortality and morbidity are found in the literature. 

A reduction in the infant mortality may be accomplished without 
the heating of the milk. This has been shown by Doctor Goler, who 
conducted an aggressive campaign to improve the milk supply for 

° Freeman, Roland G. : Medical News, Sept. 5, 1905. 



664 

infant feeding in Rochester, N. Y. His methods consisted mainly in 
education in the nursery and on the dairy farm. The clean milk 
obtained thus and distributed through milk depots resulted in lower- 
ing the death rate in children under 5 years from 33 per cent from all 
causes to 20 per cent, and now (1907) it is 15 per cent. 

Park and Holt° studied groups of infants in the tenement houses 
and institutions in New York for periods of about three months in 
the summers of two years (1902-3). This work is the most impor- 
tant evidence we have on the subject, for it combines careful clinical 
observation with laboratory studies. Although the number of cases 
was comparatively small, the results obtained were almost identical 
during the two summers, and indicate that even fairly pure milk, 
when given raw in hot weather, causes illness in a much larger per- 
centage of cases than the same milk given after pasteurization. A 
considerable percentage of infants, however, did apparently as well 
on raw as on pasteurized milk. Park and Holt conclude in part : 

The number of bacteria which may accumulate before milk becomes notice- 
ably harmful to the average infant in summer differs with the nature of the 
bacteria present, the age of the milk, and the temperature at which it has 
been kept. When milk is taken raw the fewer bacteria present the better are 
the results. Of the usual varieties, over 1,000,000 bacteria per cubic centi- 
meter are certainly deleterious to the average infant. However, many infants 
take such milk without apparently harmful results. Heat above 170° F. 
(77° C.) not only destroys most of the bacteria present, but apparently some of 
their poisonous products. No harm from the bacteria previously existing in 
recently heated milk was noticed in these observations, unless they had 
amounted to many millions, but in such numbers they were decidedly dele- 
terious. 

When milk of average quality was fed sterilized and raw, those infants who 
received milk previously heated did on the average much better in warm 
weather than those who received it raw. The difference was so quickly mani- 
fest and so marked that there could be no mistaking the meaning of the 
results. 

A few cases of acute indigestion were seen immediately following the use of 
pasteurized milk more than 36 hours old. Samples of such milk were found to 
contain more than 100,000,000 bacteria per cubic centimeter, mostly spore- 
bearing varieties. The deleterious effects, though striking, were not serious or 
lasting. 

After the first twelve months of life, infants are less and less affected by the 
bacteria in milk derived from healthy cattle. According to these observations, 
when the milk had been kept cool the bacteria did not appear to injure the 
children over 3 years of age at any season of the year, unless in very great 



a Park, Wm. H., and Holt, L. Emmett : " Report upon the results with differ- 
ent kinds of pure and impure milk in infant feeding in tenement houses and 
institutions of New York City: A clinical and bacteriological study." Medical 
News, vol. 83, 1903, p. 1066. 



665 



The general practice of heating milk, which has now become a custom among 
the tenement population of New York, is undoubtedly a large factor in the less- 
ened infant mortality during the hot months. 

Only the purest milk should be taken raw, especially in summer. 

No discussion of the subject is complete without recognition of the 
debt the world owes Mr. Nathan Straus for his early and persistent 
advocacy of pasteurization and the establishment of his infants' milk 
depots. Through his influence and philanthropy this movement has 
now spread to many cities of this country and abroad. 




C*,. 




■•••J .-*C 



INSIDE 

SECTION 

SHOWING 

BRACKET 

FOR 

TRAY 



Fig. 64.— Home pasteurizer. (See p. 675.) 

Mr. Emile Berliner, of Washington, has also for many years 
pointed out the dangers in raw milk and taught the wisdom of 
" scalding " milk. 

HOME PASTEURIZATION. 

If pasteurization is to be done perhaps the best place to do it is in 
the home, but the heating of milk to just 60° and the holding of it 
to just that temperature for twenty minutes, then cooling it rapidly, 



666 

requires intelligence and careful manipulation. With the possible 
exception of infant feeding, it would perhaps be better and cheaper 
to pasteurize the milk in bulk under competent supervision instead 
of leaving it to the usual carelessness of cooks, who can not be expected 
to master the technic nor appreciate the difficulties. Imperfect pas- 
teurization may be worse than none, for it may result only in further 
contamination of the milk. 

Milk pasteurized in the home is commonly heated too high and 
not rapidly cooled. 

The most practical home pasteurizer is that devised by Freeman." 
The following experiments, made in the Hygiene Laboratory, with 
Freeman's pasteurizer show its efficiency: 

Test No. A with Feeeman's Pasteurizer. 

Temperature of milk, 9° C. 

Temperature of water in jacket, 25° C. 

Milk introduced into boiling water and removed from the fire. 
Milk temperature — ° C. 

Five minutes after immersion in boiling water 47. 5 

Ten minutes after immersion in boiling water 63 

Fifteen minutes after immersion in boiling water 67.4 

Twenty minutes after immersion in boiling water 68. 8 

Twenty-five minutes after immersion in boiling water 68. 9 

Twenty-eight minutes after immersion in boiling water 68.9 

Whole time, twenty-eight minutes. 

Above 67° C. for thirteen minutes. 

Took fifteen minutes in running tap water, at 22° C, to cool milk to 30° C. 

The results follow: 



Milk from— 
Dairy I. 
Dairy K 
Dairy L 
Dairy M 
Dairy N 
Dairy O 
Dairy P 
Dairy Q 



Bacteria per cubic 
timeter.6 


cen- 


Raw milk. 


After pas- 
teurization. 


34,600,000 




300 


1,050,000 




50 


80,000 




400 


2, 200, 000 




200 


2,100,000 




1,200 


1, 900, 000 




None. 


2, 400, 000 




600 


2,000,000 




450 



° Freeman, Rowland G. : "Low temperature pasteurization of milk at about 68 c 
(155° F.)." Arch, of Ped., 1896. 

6 Colonies on agar plates after twenty-four hours' incubation at 37° C. 



667 

Test No. B with Freeman's Pasteurizer. 

Temperature of milk, 11° C. 

Temperature of water in jacket, 22° C. 
Temperature of milk — ° C. 

Five minutes after immersion in boiling water 50 

Ten minutes after immersion in boiling water 63 

Fifteen minutes after immersion in boiling water _ 66.6 

Twenty minutes after immersion in boiling water 67. 5 

Twenty-five minutes after immersion in boiling water 67.7 

Thirty minutes after immersion in boiling water 67. 4 

Thirty-five minutes after immersion in boiling water 67 

Forty minutes after immersion in boiling water 66.6 

Forty -five minutes after immersion in boiling water 66 

It took thirteen minutes in running tap water, at 22° C, to cool the milk to 
30° C. 

Whole time, forty-five minutes. 

Above 65° C, thirty minutes. 



Milk from— 
Dairy A . 
Dairy B . 
Dairy C . 
Dairy D . 
Dairy E. 
Dairy F . 
Dairy G . 
Dairy H . 



Bacteria per cubic 


cen- 


timeter.o 




Raw milk. 


After pas- 
teurization. 


1, 900, 000 




300 


2,500,000 




500 


2, 100, 000 




50 


440,000 




None. 


1,090,000 




200 


29, 800, 000 




1,750 


1,420,000 




None. 


590, 000 




2,650 



a Colonies on agar plates after twenty-four hours' incubation at 37° C. 

Note. — Recently (November, 1907) Freeman has modified bis pasteurizer so that the 
milk is heated to 60° C. for forty minutes. (See his article on " The ferments in milk and 
their relation to pasteurization," in the Jour, of the Amer. Med. Assn., Nov. 23, 1907, Vol. 
XLIX, No. 21, p. 1740.) 

Milk is frequently pasteurized by simply placing the bottle of milk 
as it is received in a pot of water, the water boiled for a variable 
length of time, and then cooled. As will be shown by the following 
experiments, this is not always an entirely safe procedure for the 
purposes of home pasteurization. The depth of water in which the 
bottle is immersed markedly affects the results. The neck of the bot- 
tle must always project above the water, and unless the pot has a lid 
the upper layers of the milk may escape heating, especially if the 
contents have not been well shaken up and the thick cream, which is 
in part turned to butter as a result of agitation on the delivery wagon, 
prevents circulation of the fluid. 

It will be seen in some of the experiments made by myself in the 
Hygienic Laboratory that, contrary to what might be expected from 



668 

the physics of fluids, the top layers of the milk are sometimes not as 
hot as the bottom or require a much longer time to heat up. 

Experiment No. 1. 

Pint mixed market milk. 
Bottle immersed in water to its lip. 

Distinct cream line from standing over six hours before heating; thick cream, 
almost butter, floating on top. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°C. 


°a 


°C. 


Minutes. 






26 


26.5 


25.5 




(a) 

(a) 




30 


26.5 


26.5 


2 




40 


27 


28.75 


4? 


(a) 




50 


30 


32 


7 


(a) 




60 


35 


39 


. 9h 


(a) 




70 


41 


45 


12 


(a) 




75 


45 


49 


13 


(a) 




80 


50 


53.5 


14£ 


(a) 




83 










Simmering. 


85 


55 


58 


15^ 


(a) 


87 


58 


60.5 


16i 


( b ) 




88 


60 


62.5 


16| 


( 6 ) 




91 


63 


66 


171 


(*>) 




92.5 


65 


68 


18* 


( 6 ) 




97 


70 


73 


19i 


( c ) 




98 


71 


75 


20 


( c ) 


Boiling. 


100 


75 


80 


21* 


( c ) 




100 


78 


83 


23 


( c ) 




100 


80 


85 


23i 


(d) 





a Innumerable.. 

b Somewhat less innumerable. 



c Distinctly less innumerable. 
d About 200,000. 



Experiment No. 2. 

Pint mixed market milk. 

Bottle immersed in water 6 inches, 1 inch out. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°a 

28 
60 
70 
80 
85 
90 
94 
98 
100 


°a 

14 
32 
40 
48 
50 
55 
60 
65 
70 


°C. 


Minutes. 


9,000 






5 
7 
9 

10 

11 

12 

12i 

13 












8,000 

4,000 

750 

600 

80 













669 



Experiment No. 3. 

Pint mixed market milk. 

Bottle immersed in water 6 inches, 1 inch out. 

Distinct cream line from standing twenty-four hours. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 




Top. 


Bottom. 


in agar. ! 


°C. 


-a 


°C. 


Minutes. 






23 


20 


13 




4,000 




30 
40 


21 
23 


21 
24.5 


2} 




3^ 


6,000 


50 


28 


30 


6i 






60 


35 


36.5 


H 






70 


44.5 


44.5 


9} 






80 


53 


53 


13 






81.5 


55 


54.5 


13 


9,000 




85 


60 


58 


13| 


6,000 


Simmering. 


88 


61.5 


59 


14 




Scum. 


89 


63.5 


60.5 


m 


7,500 




90 


65 


62 


14f 






92 


67 


64 


15* 


600 




95 


70 


68 


16 1,500 


Boiling. 


96 


75 


73 


18 ! 900 






77 


76 


19 (a) 


Scum. 








a Fewer, but numerous. 






Expe 


EIMENT 


No. 4. 





Pint mixed market milk. 

Bottle immersed in water 4| inches, 2h inches out. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°c. 

22 

30 
40 
50 
60 
70 
80 
85 
93 
96 


°C. 
21 
22 

22.5 
24 
27 
31 
35 
36 
44 
47 
50 
55 
58 
60 
65 


°a 

15 
17 


Minutes. 


4,300 


Simmering. 
Boiling. 


U 


20 4$ 
23 4 






25.5 
32 

40.5 

45 

54 

58 

59 

61 

62 

64 


5f 
6? 
9 

10 

11? 

12| 

13 

13* 

13* 

13* 


4,500 






6,000 


3,000 
3,200 
3,500 










65 134 


4,000 
2,000 
3,100 




70 67 14+ 




73 


68. 5 15 









670 

Experiment No. 5. 

Pint mixed market milk. 

Bottle immersed in water 4 inches, 3 inches out. 

Recently mixed, no distinct cream line. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°C. 
30 
40 
50 
60 
70 
80 
86 
90 
91 
98 


°C. 
23 
22 
24 
25 
27 
29 
32 
33 
36 
40 
50 
55 
58 
60 
63 
65 
70 


°C. 
16 
20 
23 
27 
33 
37 
45 
48 
54 
57 
65 
70 
74 
75 
80 
81 
85 


Minutes. 


480 


Simmering. 
Boiling. 


1* 
3| 
5 
6| 

8 
9 
9* 

m 

101 

m 

13* 

15 
16* 
17 
19| 








812 








760 

150 

58 

35 



1 

1 

















Experiment No. 6. 

Pint mixed market milk. 

Bottle immersed in water 3 inches, 4 inches out. 

No cream line. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°C. 

24 

40 

50 

60 

70 

80 

87 

90 

95 

100 

100 

100 

100 

100 

100 

100 


°C. 
13 
17 
20 
24 
29 
35 


°a 


Minutes. 


1,500 


At start. 

Water simmering. 

Water boiling. 

Scum 1,300. 
Scum 1,500. 
Scum 2,000. 




3 

4 

5* 

6* 

8 

9 

9s 
10* 
11* 
12* 
13* 
14* 
15* 
16 
17 






20 
24 
30 










44 


38 






55 
60 
65 
68 
70 
72 
75 
73 


49 
54 
61 
64 
67 
69 
73 


1,800 

1,700 

230 


55 


6 











671 



Experiment No. 7. 



Pint mixed market milk. 

Bottle immersed in water 3 inches, 4 inches out. 

Partial cream line. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°a 

26 
30 
40 
50 
60 
70 
80 
88 
90 
97 


°C. 

16 
19 
20 
22 
27 
33 
40 


°c. 

17 

20 

21 

22.5 

25.5 

30 

36 


Minutes. 


2,000 


Simmering. 
Boiling. 

Some scum. 
Scum. 


1 

2 

3i 

4* 

6? 

7f 

9 

9t 
10i 
11* 
Ui 
12 

3i 
141 
16 






1,000 






49 
57 
60 
63 
66 
70 
75 
78 


43.5 

51 

53 

55 

57.5 

64 

70 

75 






1,000 
350 

60 
9 
5 
2 















Experiment No. 8. 

Pint mixed market milk. 

Bottle immersed in water 5 inches, 2 inches out. 

Cream line; mixed a little, not much, with pipette. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°C. 
25 
40 
50 
60 
70 
80 
83 
86 
91 
94 
95 
97 
100 
100 
100 


°C. 
19 
23 
28 
32 
40 
49 
52 
55 
60 
63 
65 
68 
69 
72 
74 


°C. 
14.5 
22 
28 
35.5 
43 
52.5 
56 

59.5 
55 
68.5 
71 

72.5 
75 
78 
80 


Minutes. 


215 


Water boiling. 
Scum 

Do. 


3 
6i 

81 
10* 
13 
14 
15 
16* 
17 
17* 
18 
19 
19* 
20 


230 








2,000 
2,100 

(a) 
(a) 


(a) 
410 





• Lost. 



672 



Experiment No. 9, 



Quart mixed market milk. 

Bottle immersed in water to lip. 

Distinct cream line from standing at least five hours. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°C. 


°a 


°C. 


Minutes. 






24 


25 


22 




450,000 




30 


25 


24 


2i 




40 
50 


26 
28 


25 
30 


5 
H 








60 


35 


32 


12 


550,000 




70 


45 


43.5 


15 


550,000 




80 


52 


52.5 


18£ 






82 


55 


57 


19i 


550, 000 




84 


58 


57.5 


21 


650,000 




85 


60 


57.5 


21| 


550, 000 




87 
88 










Simmered. 


63 


62 


22| 


425,000 


90 


65 


64 


23 


175, 000 




97 


69.5 


71.2 


25 


13, 000 


Boiling. 


100 


75 


79.5 


28^ 


33 





Experiment No. 10. 



Quart mixed market milk. 
Bottle immersed in water to lip. 
Recently mixed, no distinct cream line. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°C. 


°C. 


°C. 


Minutes. 






27 
30 


24 
24.5 


20 
20 




27 




1 


40 
48 


29.5 
35 


21 


5* 






296 


50 
60 


36 
44 


27 
32 


6 

8^ 








65 


45 


33 


% 


208 




69 


50 


37 


11 


1,400 




70 


51.5 


37.5 


114 






74 


55 


39 


12^ 


874 




76 


58 


41 


12| 


3,180 




78 


60 


43 


13i 


1,930 




80 
81 


62 
" 63 


45 
46 


14 
14| 




Simmering. 


1,300 


83 


65 


47.5 


15 


370 




88 


70 


53 


16 


115 




90 


72 


56 


m 






95 


75 


61 


m 


59 




100 


80 


65.5 


20 




Boiling. 





673 



Experiment No. 11. 
Quart mixed market milk. 

Bottle immersed in water 5 inches, 4 inches out. 
No distinct cream line. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies, 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°a 

28 
40 
50 
60 
70 
80 
85 
90 
97 


23 

23.5 

24 

24.5 

25 

30 


°a 

16 
20 
23 
28 
32 
40 


Minutes. 


7,100 


Simmering. 
Boiling. 


2$ 

6i 

8} 

10* 








12,000 


38 
41 
50 
55 
58 
60 
61 
65 
68 
70 


51 
56 
64 
67 
71 
72 
74 
75 
77 
78 


13| 

15 
16 
18 
19? 
20 
20A 
21 
21| 
22 






9,500 
7,400 
5,400 










2,200 






3,600 

1,700 







Experiment No. 12. 
Quart mixed market milk. 

Bottle immersed in water 5 inches, 4 inches out. 
Distinct cream line. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom . 


°a 

24 
30 
40 
50 
60 
70 
80 
84 
90 
95 


°<7. 
18 

18.2 
19 
20 

23.5 
31 
37 
39 
45 


°C. 
14 


Minutes. 


26,000 


Simmering. 
Boiling. 


2} 
3f 
5| 
7| 
9| 

m 

12 

14 

15 

16 

16| 

16| 

17 

17* 

17| 

18 

18| 

20£ 


20 
26 
30 
35 
41 
44 
50 


30,000 














58 
61 
65 

68 
70 
72 
74 
75 
80 


59 

60 

62 

62.5 

63 

64 

65 

66.5 

72 


30,000 
21,000 
25,000 
33,000 
18,000 
12, 000 
9,000 
9,000 























45276°— Bull. 56—12- 



-43 



674 



Experiment No. 13. 
Quart mixed market milk. 

Bottle immersed in water 4 inches, 5 inches out. 
Cream line very distinct from long standing. 

The bottom milk hotter than the top, probably on account of heavy viscid 
cream on top that did not circulate. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°a 


°C. 


°C. 


Minutes. 






20 


20 


12 




a 4, 000 




30 
40 


20 
20.5 


14 
16 


3 






50 


21 


20 


6f 






60 
70 


21.5 
22 


24 

28 


8i 
10i 








80 


23 


36 


12* 






86 


26 


41 


13^ 




Simmering, 


90 


28.5 


43 


13* 




95 


35 


47 


15* 




Boiling, 


100 


44 


55 


17 


( 6 ) 


100 


49 


60 


18* 


a 4, 000 




100 
100 


50 
54 


61 
65 


19i 
20 






(*) 


100 


60 


70 


22| 


( b ) 




100 


63 


72 


23 


340 




100 


65 


74 


24 


150 




100 


70 


79 


26* 


8 




100 
100 


73 
75 


82 
83 


28 
30 






13 



a About. 

Experiment No. 14. 
Quart mixed market milk. 

Bottle immersed in water 4 inches, 5 inches out. 
No cream line. 



b Lost. 



Water 
temper- 
ature. 


Milk temperature. 


Time. 


Colonies 
per loop 
in agar. 


Remarks. 


Top. 


Bottom. 


°C. 
22 
30 
40 
50 
60 
70 
80 
90 
95 


°C. 
13 
15 
18 
22 
27 
32 
39 
47 
50 


°C. 


Minutes. 


5,760 


Boiling. 

At 66°, scum. 
Scum. 




2 
4 
5 
8 

Si 
10 
12 
13 
• 14 
14 
15 
16 
18 
19 


































100 
100 
100 
100 
100 


55 
60 
65 
70 
73 




8,000 

14, 000 

4,000 

389 















675 

Nathan Straus has modified the Freeman pasteurizer by leaving off 
the cups, thus making it simpler and cheaper. He gives the following 
directions for the manufacture of this home pasteurizer : 



Size I: 

Eight 

3-ounce 

bottles. 



Size II: 

Eight 

6-ounce 

bottles. 



Size III: 
Six pint 
bottles. 



Height of pan 

Diameter of pan 

Distance of top of bracket from bottom of pan 
Amount of water 



10£- inches . . 

....do 

3^ inches . . 
5 quarts 



10 j inches . . 

do 

4| inches . . . 
6£ quarts . . . 



14J inches. 
10£ inches. 
6£ inches. 
9 quarts. 



The following directions are abstracted from Mr. Straus's instruc- 
tions for the use of his home pasteurizer : 

Emphasis is laid on the fact that only fresh, clean milk, which has been kept 
cold, should be used. 

After the bottles have been thoroughly cleaned they are placed in the tray 
(A) and filled to the neck. Then put on the corks or patented stoppers without 
fastening them tightly. 

The pot (B) is now placed on the wooden surface of the table or floor and 
filled to the supports (C) with boiling water. 

Place the tray (A) with filled bottles into the pot (B) so that the bottom of 
the tray rests on the supports (C), and put cover (D) on quickly. 

After the bottles have been warmed up by the steam for five minutes, re- 
move the cover quickly, turn the tray so that it drops into the water, replace 
the cover immediately. This manipulation is to be made as rapidly as possible 
to avoid loss of heat. Thus it remains for twenty-five minutes. 

Now take the tray out of the water and fasten the corks or stoppers air- 
tight. Cool the bottles with cold water and ice as quickly as possible, and keep 
them at this low temperature until cold. 

Use the milk from the bottles and do not pour it into another vessel. 

The milk must not be used for children later than twenty-four hours after 
pasteurization. 

COMMERCIAL PASTEURIZATION". 

The commercial pasteurization of milk leaves much to be desired, 
but although it is not always thoroughly carried out, it is by no 
means a fraud. With a little sanitary supervision on the part of 
health officers and education on the part of those in charge of the 
process it may be made efficient. 

Commercial pasteurizers are popular with dairymen, not because of 
the public health aspect, but on account of the economic advantages 
in improving the keeping qualities of the milk. It is estimated that 
the expense of a pasteurizer would be paid for in the course of about 
a year. This estimate is based mainly on the saving of losses from 
sour milk. The cost of pasteurization is about one-tenth to one-half 
cent a quart. 



676 

In order to satisfy public health requirements pasteurizers must 
be efficient in operation, permitting a definite quantity of milk to be 
heated to a definite temperature for a definite time (Russell). They 
must be easy of control, the milk must be heated uniformly through- 
out, the apparatus must be simple in construction, easily cleaned, eco- 
nomical in use, and arranged to safeguard against reinfection of the 
milk. Finally, provision must be made for rapid cooling. Given 
an apparatus of proper construction more depends upon the intelli- 
gence and care with which it is run than upon the machine. No pas- 
teurizer is automatic. For instance, I have found that the milk 
pasteurized in a standard machine contained many more bacteria 
after the process than before. This was not the fault of the machine, 
but due to ignorance and uncleanliness. 

The following figures show the efficiency of a commercial pasteur- 
izer operated under intelligent though not skilled supervision : 



Colonies per cubic cen- 
timeter. 


Colonies per cubic cen- 
timeter. 


Before pas- 
teurization. 


After pas- 
teuriza- 
tion. 


Before pas- 
teurization. 


After pas- 
teuriza- 
tion. 


92, 000 

142, 000 

71,000 

93,000 

105, 000 

1,680,000 


2,200 
6,000 
6,000 
6,900 
38, 000 
80,000 


380, 000 

214, 000 

6,700 

900,000 

7, 000, 000 

74, 000 


83, 000 
87,000 
28, 200 
100, 000 
70, 000 
35,000 



The above figures were obtained from a type of machine known as 
a " Flash pasteurizer," in which the milk is heated momentarily at 
73° to 74° C. 

The pasteurization of milk is such an important public health 
measure that it should be under the immediate and constant super- 
vision of the health officer. The milk should be heated a definite 
temperature for a definite time and then promptly cooled and prop- 
erly labeled. 



RESUME ADVANTAGES AND DISADVANTAGES. 

Pasteurization saves lives and prevents sickness. Weighing against 
this great merit we have certain disadvantages connected with the 
heating of milk. That there are two sides to the question may be 
judged from the fact that those who have given the matter careful 
consideration come to diametrically opposite conclusions. From a 
theoretical standpoint some believe pasteurization to be an unsatis- 
factory and very feeble way out of a very difficult situation. From 
a practical standpoint, others find in pasteurization our only practi- 



677 

cable safeguard, at least until the general supply consists of good, 
clean, fresh, safe milk. 

One of the chief objections to pasteurization is that it promotes 
carelessness and discourages the efforts to produce clean milk. It is 
believed that the general adoption of pasteurization will set back 
improvements at the source of supply and encourage dirty habits. 
It will cause the farmers and those who handle the milk to believe 
that it is unnecessary to be quite so particular, as the dirt that gets 
into the milk is going to be cooked and made harmless. It is not 
proposed that pasteurization shall take the place of inspection and 
improvements in dairy methods. To insure the public a pure and 
safe milk supply should be regarded as one of the most important 
duties of the health officer. Whether pasteurization is adopted by a 
city for its general milk supply or not, no milk should be accepted 
that does not comply with certain reasonable chemical and bacterio- 
logical standards. This would aid the inspectors in enforcing good 
dairy methods. Pasteurization then must not be used as an excuse to 
bolster up milk unfit for home consumption. To insure this end, the 
health officer should have authority to condemn and destroy bad milk, 
whether or not pasteurization is practiced. 

To obtain a good milk supply involves not only an expensive 
system of inspection and surveillance from the farm to the consumer, 
but intelligence and a high degree of technical skill on the part of 
the producer and all others who handle the milk. 

We can scarcely conceive of an inspection so thorough and constant 
as to prevent milk occasionally becoming contaminated with the 
germs of typhoid, diphtheria, scarlet fever, dysentery, tuberculosis, 
etc. 

If our drinking water is defiled at its source we boil or filter it. 
It would be much better to prevent its contamination. The same is 
true of milk. We prefer pure milk, but so long as we can not obtain 
it we must purify what we get. The situation may well be illustrated 
by the attitude of an eminent sanitarian in New York, who in his 
writings and public addresses discourages pasteurization, because 
theoretically it does not reach the source of the evil, and is not as 
good in the end as purification of the milk supply through efficient 
inspection. However, when this same sanitarian is consulted by a 
large wholesale dealer of New York, who handles many thousands of 
quarts of more or less old dirty milk a day, he is confronted by a con- 
dition, not a theory, and advises pasteurization. 

There is a prevalent impression that the pasteurization of milk 
improves that important article of diet. Heating does not render 
milk better in any way as a food. All it does is to destroy certain 
bacteria and some of their toxic products. It checks certain proc- 
esses of fermentation and putrefaction, thus rendering the milk safer. 



678 

On the other hand the evidence seems clear that the pasteurization 
of milk at 60° C. for twenty minutes does not appreciably deteriorate 
its quality or lessen its food value. 

Pasteurization has been accused of possessing the great disad- 
vantage of inducing scurvy and rickets. It is generally believed that 
highly heated milk is a contributive factor in the etiology of scurvy. 
There is certainly no evidence to show that low temperature pasteuri- 
zation, such as is now recommended, ever in itself induces scurvy. 
Thousands of children have been raised upon heated milk without the 
production of this disease, which is comparatively rare, especially in 
countries such as Germany and France, where the artificial feeding 
with heated milk is most popular. Scurvy is preventable and amen- 
able to treatment. Rickets results from defective alimentation and 
improper hygiene and can not be laid at the door of pasteurization. 

Comparative observations upon infants under the same conditions 
show that they flourish quite as well upon heated milk as upon raw 
milk. Laboratory experiments as well as clinical observations coin- 
cide with the view that heated milk is quite as digestible as raw milk. 
In fact, it is now claimed to be more so. Metabolism experiments in- 
dicate that the utilization of calcium and iron in the body is more 
complete in children fed upon boiled cow's milk than in those fed 
upon raw cow's milk. 

One of the great objections to the pasteurization of milk is that it 
devitalizes it. If milk contains " life " it has probably lost the last 
vestige of it after it is from twenty-four to forty-eight hours old and 
kept under such conditions that it contains myriads of bacteria. It 
has been shown that heating milk to 60° C. for twenty minutes, while 
it kills the pathogenic organisms, does not seriously affect the enzymes, 
and the enzymes are the nearest approach to ' ; life " with which we 
are familiar in milk. The germicidal properties of milk are not seri- 
ously injured at 60° C. 

Another objection frequently urged against pasteurization is that 
some of the bacterial toxins are not killed at the ordinary tempera- 
tures used. We do not even know the nature of these poisonous prod- 
ucts in milk, much less their thermal death points. The true bacterial 
toxins are destroyed by heating to a temperature of 60° C. for twenty 
minutes. It must be remembered that if milk contains bacterial 
toxins not destroyed by pasteurization it will contain these same poi- 
sons if the milk is consumed raw. In fact, the heating of the milk 
prevents the further formation of such injurious substances. 

Pasteurization results in the destruction of the ordinary acid- 
producing bacteria, nature's danger signal of old milk. The heating 
interferes with the souring process, so that fermentation of another 
and perhaps more serious nature may take place without the knowl- 
edge of the consumer. It has been shown that certain resistant spore- 



679 

bearing bacteria have the property of peptonizing the albumens in 
milk. These bacteria survive the process of pasteurization, and are 
thus given a free field for growth, whereas in the raw milk these 
bacteria are largely held in check by the growth of the lactic acid 
forming organisms. This view started with the work of Fliigge and 
has gradually lost ground for lack of clinical and laboratory con- 
firmation. For instance, Park and Holt found that a few cases of 
acute indigestion immediately followed the use of pasteurized milk 
more than thirty-six hours old. Samples of such milk were found to 
contain more than 100,000,000 bacteria per cubic centimeter, mostly 
spore-bearing varieties. The deleterious effects, though striking, 
were not serious or lasting. However, so long as the danger is sus- 
pected it makes us cautious to keep pasteurized milk cold and use 
it promptly. 

If it is important for milk to contain lactic acid bacteria. They 
may readily be added in pure culture after the milk has been 
pasteurized. 

We are told that heating destroys great numbers of bacteria in 
milk, and thus conceals dirt, but Theobald Smith a points out — 

that from a bacteriological standpoint the pasteurization of milk will not con- 
ceal dirt, for the reason that the bacteria that come from the udder or the teats 
will be destroyed, but the bacteria that come from dirt are largely spore-bearing 
bacteria and these survive. I believe that we could control the quality of milk 
quite as well after it was pasteurized by bacteriological counts as before, be- 
cause certain species only would grow or multiply and the indicators would be 
much better than to-day. If we examine a plate made from milk, for instance, 
nobody can tell exactly whether the bacteria are due to dirt or whether they are 
due to the multiplication of ordinary lactic acid bacteria, unless a very careful 
study of that plate be made. As a rule, if nearly all the colonies are alike we 
say that they are the result of multiplication; if they are quite different then 
there has been a good deal of dirt added to the milk. Now it seems to me that 
with pasteurization it would be possible to control the dirt in milk much better 
than is done to-day. 

Further, it is said that we must not meddle with nature ; that pas- 
teurization is an artificial expedient. Nature never intended milk to 
be collected, transported, and fed to young mammalian animals one 
or two days after it leaves the mammary gland. Even when fresh, 
the milk of one species is not well suited to the needs of the young of 
another species. In the artificial feeding of infants with cow's milk, 
we are meddling with nature. When artificial feeding is necessary 
we must endeavor to obtain fresh, pure milk. If this is not possible 
the milk should be purified, especially in the hot weather. Each in- 
fant is a law unto itself. 

Smith, Theobald : Am. Journ. Pub. Health and Journ. Mass. Assn. Bds. 
Health, vol. 17, 1907, p. 200. 



680 

Pasteurization of all of the milk supply of a community may not be 
desirable. The clean, fresh milk, free from contamination, may not 
need it. Special cases may require raw milk, but the general public 
should be protected against the old, dirty, and uncared for milk 
which forms the bulk of the supply of large cities. 

The heating must be done intelligently and under the supervision of 
the health officer. After heating, the milk is just as liable to serious 
contamination as before, if not more so. It must therefore be care- 
fully guarded, kept cool, and promptly delivered. 

Theobald Smith, a 1907, expressed the opinion that pasteurization is 
the inevitable outcome of the future. He sa}^s : 

It seems to me that the real difficulty of the present condition is the trans- 
mission of specific disease germs which are not easily controlled by any amount 
of cleanliness, and these specific disease germs, one and all of them, may be 
destroyed by the average pasteurization. 

Sedgwick h voices the opinion of many sanitarians when he states 
that— 

when all is said and done, I agree with Professor Smith that we have got to 
pasteurize milk. Cooked milk is the only safe milk and always will remain 
the only safe milk for the use of mankind. Little by little the idea is spread- 
ing that raw milk is apt to be dangerous milk. 

Theoretically, pasteurization should not be necessary; practically, 
we find it forced upon us. The heating of milk has certain disad- 
vantages which must be given consideration, but it effectually 
prevents much disease and death, especially in infants during the 
summer months. 

° Smith, Th. : Discussion of Rotch's paper on " The pasteurization of milk for 
public sale." Am. Journ. Pub. Hyg., vol. 17, May, 1907, p. 200. 

6 Sedgwick, W. T. : Discussion of Harrington's paper on " Some of the ways 
in which infection is disseminated." Journ. Mass. Assn. Bds. Health, vol. 14, 
Feb., 1904, p. 41. 



22. THE THERMAL DEATH POINTS OF PATHOGENIC 
MICRO-ORGANISMS IN MILE. 



(681) 



THE THERMAL DEATH POINTS OF PATHOGENIC MICRO- 
ORGANISMS IN MILK.° 



By Milton J. Rosenau, 
Surgeon and Director Hygienic Laboratory, U. 8. Public Health and Marim- 

Hospital Service. 



The temperature at which milk should be pasteurized hinges on the 
thermal death points of the pathogenic micro-organisms which con- 
taminate it. The micro-organisms pathogenic for man most frequently 
found in market milk are those causing tuberculosis, typhoid fever, 
diphtheria, scarlet fever, dysentery, and Malta fever. Fortunately 
none of the organisms causing the above-mentioned acute diseases 
have resisting spores. Moderate degrees of heat are, therefore, suffi- 
cient to render milk safe so far as these dangers are concerned. The 
streptococci, staphylococci, and most of the bacteria associated with 
infantile diarrhea are also readily destroyed by heat. 

Although it would appear to be a comparatively simple matter 
to determine precisely the temperature at which micro-organisms die, 
such work is in fact surrounded by many difficulties and pitfalls; 
different investigators have come to widely different results. Some 
of these discrepancies are only apparent and may be explained by the 
relation of time to temperature. The longer the time of exposure, the 
lower the temperature necessary to kill any organism. Differences in 
methods are also responsible for difference in results. 

Among bacteria some strains or races are more resistant to heat 
than others. These differences, which correspond to similar known 
variations in all animal and vegetable species, must be taken into 
account. 

Evaporation takes place so rapidly from exposed fluids that the sur- 
face layer may remain cooler than the body of the liquid. This is 
especially a matter of concern with milk, which sometimes forms a 
scum above 60° C, owing to rapid evaporation of the surface layer. 
This scum consists of coagulated albumins in which is enmeshed much 
fat. The bacteria entangled in this surface pellicle may escape the 
heat indicated by the thermometer in the deeper layers. 

a This article is a brief summary of Hygienic Laboratory Bulletin No. 42, 
entitled " The thermal death points of pathogenic micro-organisms in milk." 
For all the details of the work the reader is referred to that bulletin. 

(683) 



684 

As a rule, bacteria are attenuated and lose their power to infect 
before they lose their ability to vegetate upon artificial culture media. 
It is therefore safe to assume that a micro-organism that will not grow 
in artificial media under favorable conditions is " dead." The tuber- 
cle bacillus is an exception to this rule, for reasons given further on. 

The methods used in the tests recorded below were planned to imi- 
tate the actual conditions of pasteurization, so far as practicable, in 
laboratory experiments. 

The test tubes in which the infected milk was heated were open to 
the air, and scum formation was disregarded in all instances, my ob- 
ject being to determine the thermal death point against natural diffi- 
culties, so that the results might be applied with confidence to prac- 
tical pasteurization. 

BACILLUS TUBERCULOSIS. 

Certain special difficulties are met with in determining the thermal 
death point of the tubercle bacillus. This organism does not grow 
readily upon artificial media. The few experiments made to deter- 
mine its thermal death point by cultural methods have no significance, 
because its vegetability upon artificial media does not correspond to 
its power of growing in the animal organism. It is therefore neces- 
sary to inoculate animals in order to determine whether or not the 
tubercle bacillus is alive and virulent. Here again we meet with 
complications. Dead tubercle bacilli have a certain amount of patho- 
genic power and produce lesions, including tubercle formation, ab- 
scesses, and coagulation necrosis. However, while we lack a criterion 
to determine with precision the exact point when the tubercle bacillus 
dies, we are able by means of animal inoculations to determine just 
when the tubercle bacillus is so enfeebled that it is no longer able to 
infect. This, after all, is the important practical point. 

In my own experiments, in order to avoid the confusion resulting 
from the effects produced by dead tubercle bacilli, doubtful lesions 
were carried over into another animal. 

From these experiments it is evident that the tubercle bacillus in 
milk loses its infective properties for guinea pigs when heated to 
60° C. and maintained at that temperature for twenty minutes or 
to 65° C. for a much shorter time. 

It should be remembered that the milk in these tests was very 
heavily infected with virulent cultures, indicated by the prompt 
deaths of the control animals. Milk would practically never contain 
such an enormous amount of infection under natural conditions. It 
is justifiable to assume that if 60° C. for twenty minutes is sufficient 
to destroy the infectiveness of such milk when injected into the 
peritoneal cavity of a guinea pig, any ordinary market milk after 



685 

such treatment would be safe for human use by the mouth so far as 
tubercle bacilli are concerned. 

It is difficult, if not impossible, to briefly summarize the work of 
others upon the thermal death point of the tubercle bacillus in milk. 
The following table necesarily leaves out many factors : 



Table showing the thermal death point of the tubercle bacillus as found by 

various investigators. 



Investigator. 


Killed at— 


Not killed at — 


Martin 1882 




80°. 


May 1883 






Sormani, 1884 


Boiling, 5 minutes 


90° for 10 minutes. 


Schill and Fisher, 1884 




100°. 


Voelsch, 1887 




100°, boiling twice. 


Yersin, 1888 


J60°, 10 minutes ( —spores) 

(60°, 10 minutes ( +spores) 

68°, 20 minutes 


Bitter, 1890 




Bang, 1891 


70°, 5 minutes (enfeebles) 

60°, 5 minutes (sometimes en- 
• feebles). 
80° (sometimes kills) 








% 






Bonhoff , 1892 


60°, 20 minutes 




Gancher and Ledeux-Lebard, 1892 . . 


f 60°, 5 minutes (attenuates) 

[70°, 1 minute (kills) 






J60°, 6 hours 


[55°, 3 hours. 
<,60°, 45 minutes. 


Forster, 1892 


(95°, momentary 




(80°, momentary. 
[60°, 45 minutes. 




J55°, 4 hours 


De Man, 1893 


[60°, 1 hour 




Schroeder, 1894 


60°, 15 minutes 




[50°, 15 hours 






60°, 8 hours 




Woodhead, 1895 


- 60°, 45 minutes 


•90° (results contradictory). 








70°, 2^ minutes 




Marshall, 1899 


68°, 20 minutes 


60°, 10 minutes. 


Th. Smith, 1899 


60°, 15 to 20 minutes 






55°, 3 hours 


J70°, 10 minutes. 
[100°, momentary. 


Kobrak, 1900 


50°, 4 hours 




100°, 3 hours 


J100°. 

[80°, 30 minutes. 

85°, 6 minutes. 


Galtier, 1900 




Bussell and Hastings, 1900 


60°, 20 minutes 




Herr, 1901 






Hesse, 1901 


60°, 20 minutes 




Levy and Bruns, 1901 






Berthcl and Stenstrom, 1901 




70°, 15 minutes. 
60°, 15 minutes. 


Bang, 1902 




Tjaden, 1903 


85°, 1 to 2 minutes. .. 




Rullmann, 1903 


65°, 30 minutes . . . 




Barthel and Stenstrom, 1904 


80°, 1 minute (uncoagulated) 


80°, 1 minute (coagulated). 


Russell and Hastings, 1904 


Zelenski, 1906 






Rosenau, 1907 


60°, 20 minutes 











686 

The above tabular statement shows that my results agree with the 
work of Yersin, Bonhoff, Schroeder, Th. Smith, Russell and Hast- 
ings, and Hesse in that 60° for twenty minutes is sufficient to kill the 
tubercle bacillus. 

The lesions produced by a large mass of dead tubercle bacilli may 
be distinguished by their extent rather than by their character. In 
doubtful cases secondary inoculation is the only trustworthy method 
of determining whether the bacilli are alive or dead. The tuberculin 
test does not differentiate between the live and dead tubercles. Three 
guinea pigs out of eight having lesions produced by dead tubercle 
bacilli (killed at 100° C.) died as the result of the subcutaneous inoc- 
ulation of 2 c. c. tuberculin (O. T.). 

CONCLUSIONS. 

The evidence is plain that milk heated to 60° C. and maintained at 
that temperature for two minutes will kill the typhoid bacillus. The 
great majority of these organisms are killed by the time the tempera- 
ture reaches 59° C, and few survive to 60° C. 

The diphtheria bacillus succumbs at comparatively low tempera- 
tures. Oftentimes it fails to grow after heating to 55° C. Some 
occasionally survive until the milk reaches 60° C. 

The cholera vibrio is similar to the diphtheria bacillus so far as its 
thermal death point is concerned. It is usually destroyed when the 
milk reaches 55° C. ; only once did it survive to 60° C. under the 
conditions of the experiments. 

The dysentery bacillus is somewhat more resistant to heat than the 
typhoid bacillus. It sometimes withstands heating at 60° C. for five 
minutes. All are killed at 60° C. for ten minutes. However, the 
great majority of these micro-organisms are killed by the time the 
milk reaches 60° C. 

So far as can be judged from the meager evidence at hand, 60° C. 
for twenty minutes is more than sufficient to destroy the infective 
principle of Malta fever in milk. The M. melitensis is not destroyed 
at 55° C. for a short time; the great majority of these organisms die 
at 58°, and at 60° all are killed. 

Milk heated at 60° C. and maintained at that temperature for 
twenty minutes may therefore be considered safe so far as conveying 
infection with the micro-organisms tested is concerned. 



23. INFANT FEEDING. 



(687) 



INFANT FEEDING. 



By Joseph W. Schereschewsky, 
Passed Assistant Surgeon, Public Health and Marine-Hospital Service. 



PART I.— INFANT MORTALITY IN RELATION TO INFANT FEEDING. 

Owing to the long duration of the period of infancy in human 
beings, as compared to that of the lower animals in general, it is 
obvious that the opportunity of environment to react upon our de- 
velopment is enormously increased over that afforded in the case of 
other living beings. 

The effect of prenatal influences upon our ultimate development 
receives no further accretions from the moment of our birth, and, 
apart from those congenital defects and states of debility, whose 
influence upon life are manifest from the outset, our subsequent 
growth and development are almost exclusively controlled by our 
immediate surroundings. 

More than any other component factor of its environment, food, 
the form and the methods of its administration, are capable of in- 
fluencing the future development and determining the fate of the 
newborn child. 

If this statement be true, we should expect to find that an investi- 
gation of the mortality rates of infants would furnish some relevant 
facts in regard to this question. 

Unfortunately, even at the present time infant mortality and the 
degree to which such mortality is influenced by improper methods of 
feeding is not a subject of general knowledge. True, it is known as 
a matter of casual information that the rate of mortality among the 
newborn is relatively high, yet few who have not paid attention to the 
matter realize, as Bergeron so graphically puts it, that the chances of 
a newborn child surviving a week are less than those of a man of 90 ; 
of living a year, less than those of a man of fourscore. 

Information as to the infantile death rate in this country is difficult 
to derive, owing to the small number of States within our registra- 
tion area and the poverty in detail of their statistical returns. The 
writer is, however, much indebted to Harrington, who has made an ex- 
tensive study of this question in a recent article from which many of 

45276°— Bull. 56—12 44 (689) 



690 

the following figures and facts are taken. The perusal of his article 
is recommended to those who desire a more extended treatment of this 
phase of the subject. Eeference to the report of the Bureau of Cen- 
sus for 1900 shows that the general infantile mortality rate per thou- 
sand in the States which constituted our registration area at that time 
is as follows: 



Table 1. 



District of Columbia 274. 5 

Rhode Island 197.9 

Massachusetts 177. 5 

New Hampshire 172. 

New Jersey 167.4 



New York 159. 8 

Connecticut 156. 8 

Maine 144. 1 

Vermont 122. 1 

Michigan 121. 1 



These figures show the wide variations to which the infantile 
mortality rate is subject in different parts of this country. The low- 
est mortality rate, 121.1 (Michigan), is less than half the highest 
(Washington, D. C). 

On comparing them with foreign countries, however, they do not 
strike us as extraordinarily high. The death rate of Washington, 
D. C, is similar to that of Eussia, while the rate of the lowest (Michi- 
gan) corresponds to that of Scotland, but exceeds that of three other 
European countries, viz, Ireland (average of twenty years, 1874 to 
1893, 96.6), Norway (1902, 75.08), and Sweden (1902, 87). 

As is to be expected, our cities show a higher infant mortality rate 
than our States. The census report of 1900 gives 106 towns and 
cities which have an infant mortality of 175 or over. The maximum 
infant death rate was shown by Charleston, S. C, with a rate of 
419.5, while Los Angeles, Cal., with a rate of 175, occupied the last 
place. 

The following cities showed a death rate of over 300 per 1,000 
births : 

Table 2. 



Charleston, S. C 419. 5 

Savannah, Ga 387.5 

Mobile, Ala 344. 5 

Key West, Fla 311.8 

Biddeford, Me 311.6 



Atlanta, Ga 306. 

Fall River, Mass 304.7 

Lynchburg, Va 301. 7 

Richmond, Va 300.1 



The following large representative cities had an infantile mor- 
tality rate as follows: 



a Harrington, Am. Jour. Med. Sci., Vol. CXXXII, pp. 811-835. 



691 

Table 3. 



Washington, D. C 274. 5 

Baltimore, Md 235. 1 

New Orleans, La 229. 2 

Philadelphia, Pa 197.2 



Brooklyn, N. Y 197. 2 

Boston, Mass 194. 1 

Borough of Manhattan 190. 9 

New York, N. Y 189. 4 



The poverty of our vital statistics does not, however, permit us to 
analyze these figures as to the incidence of various infantile con- 
ditions and diseases causing death. In order to interpret their sig- 
nificance, we must resort to the statistics of foreign countries, most of 
which have complete and excellent systems for the registration of 
death returns. 

Inasmuch as in civilized countries similarly situated with respect 
to latitude the circumstances affecting mortality are approximately 
the same, it may be postulated that conditions shown to exist abroad 
are duplicated here. 

Owing chiefly to her falling birth rate, the state of infant mor- 
tality in France has for some years been a subject of acute interest 
both to her Government and to her medical profession. We find that 
the average infantile mortality rate of France has been 167 for the 
twenty-year period of 1874-1893. In 1903 this rate had fallen to 137, 
and contrary to what is usually the case was lower than this in some 
of her largest cities, such as Lvon (110), Bordeaux (102), and Paris 
(101). 

In January, 1901, Balestre and Gileta de St. Joseph presented a 
memoir to the Academie de Medecine dealing with the infant mor- 
tality of France from the years 1892 to 1897, with special reference to 
the various causes of death constituting the total infant mortality 
rate. a 

Their analysis showed that in every 1,000 infant deaths under 1 
year of age no less than 385 were due to gastro-intestinal disease, 171 
were due to congenital states of debility, 147 to disease of the respira- 
tory organs, 50 to acute contagious disease, 25 to tuberculosis, and 222 
to all other causes. This was the average for the whole country. In 
certain cities the death rate from gastro-intestinal disease was enor- 
mously increased, being 700 per thousand infant deaths in the city of 
Troyes in 1892. 

In 1905 Ausset 6 published a report on the infant mortality of the 
Departement du Nord practically confirming the figures of Balestre 
and Gileta de St. Joseph. 

a Kept, by M. Perret, Revue d'Hygiene et de Med. Infantiles, 1905, IV, 160. 
6 E. Ausset, Revue d'Hygiene et de Med. Infantiles, 1905, II, 433. (Cited by 
Harrington. ) 



692 

The following table gives the number of deaths from gastrointes- 
tinal diseases per thousand deaths in infants of less than 1 year of 
age in certain parts of the Departement du Nord: 

Table 4. — Deaths from gastro-intestinal disease per 1,000 infant deaths, Departe- 
ment du Nord, France. 



District of Dunkerque 445.08 

Canton Bergues 410. 61 

Canton Bourbourg 485. 38 

Canton Wormhoudt 602.86 

Canton Gravelines 404. 40 

2 cantons of Dunkerque. 465. 00 

District of Lille 401. 26 

Canton Armentieres 416.66 

Canton Quesnoy-sur-Lille__ 420. 28 

Canton Seclin 383.37 

Canton Launay 398.87 

Canton Rontaix 464.33 



District of Lille — Continued. 

3 cantons of Tourcoign 457. 77 

8 cantons of Lille 427.83 

District of Hasebrouck 395.20 

Canton Merville 363.60 

Canton Steenvoorde 394.44 

Canton Cassel 454.66 

3 cantons of Bailleul 431. 11 

District of Valenciennes 313. 92 

Canton Denain 342.10 

Canton Conde 337.07 

Canton Bouchain 392.40 



In Germany, which has the second highest infantile mortality rate 
in Europe, being surpassed " in this bad eminence " only by Russia 
(which in some districts has an infantile mortality rate surpassing 
500, and for the whole country one of 270) , we find that the infantile 
mortality rate for the quinquennium of 1901-1905 is as follows : 

Table 5. — Average infant mortality under 1 year per 1,000 births in Germany, 

1901-1905. 



1901 
1902 
1903 



207 
183 
204 



1904 
1905 



196 

205 



In 1904 the average rate for 323 German cities and towns having 
a population of 15,000 or over was 202 ; in 1905 it was 204. 

In the latter year the average rate of 42 German cities each with 
a population exceeding 100,000 was 202, and for the twelve months 
ending June 30, 1906, was 198. The returns of that year from these 
42 German cities show further that of 67,637 infant deaths no less 
than 28,423, or 44.03 per cent, were due to diarrheal disease. 

The excellence of the German system of registration of vital sta- 
tistics permits us to examine the local incidence of deaths from gastro- 
intestinal disorders. 

I have taken the liberty of combining two of the tables in Harring- 
ton's a admirable article into the following, which shows the birth 
rate, the diarrheal death rate, and, finally, the percentage the diar- 
rheal death rate constitutes of the total infantile mortality in the 42 
German cities listed in the table for the twelve months ending June 
30, 1906: 



o Harrington, Am. Jour. Med. Sci., Vol. CXXXII, pp. 811-35. 



693 



Table 6. — (After Harrington.) 



Name of city. 



Births, 

July 1, 1905, 

to June 30, 

1906. 



Deaths 

under 1 

year of 

age. 



Death 

rate per 

1,000 

births. 



Diarrheal 
death 
rate. 



Per cent 
of deaths 

due to 
diarrhea. 



Aachen 

Altona 

Barmen 

Berlin 

Borkum 

Bremen 

Breslau 

Brunswick 

Cassel 

Charlottenburg 

Chemnitz 

Cologne 

Crefeld 

Dantzig 

Dortmund 

Dresden 

Duisberg 

Dusseldorf 

Elberfeld 

Erfurt 

Essen , 

Franf ort -on-the-Mai n 

Gelsenkirchen 

Halle... 

Hamburg 

Hanover 

Karlsruhe 

Kiel 

Koenigsberg 

Leipzig 

Magdeburg 

Mannheim 

Munich 

Nuremberg 

Plauen 

Posen 

Rixdorf 

Schoeneberg 

Stettin 

Strassburg 

Stuttgart 

Wiesbaden 



4,300 
4,405 
4,597 

49, 708 
5,060 
6,429 

14,366 
3,397 
3,202 
5,189 
8,314 

15,373 
2,572 
5,288 
7,385 

14, 297 
7,524 
8,868 
4,963 
2,966 
9,494 
9,335 
7,451 
4,985 

20,471 
5,908 
3,052 
5,083 
6,671 

14, 734 
6,304 
5,170 

15,787 

10,290 
3,745 
5,123 
5,547 
3,200 
7,089 
4,794 
6,176 
2,489 



749 

605 

9,933 

818 

1,116 

3,511 

668 

407 

803 

2,253 

3,266 

390 

1,286 

1,366 

2,735 

1,137 

1,667 

739 

597 

1,498 

1,446 

1,169 

1,175 

3,538 

949 

565 

903 

1,556 

3,273 

1,472 

1,053 

3,432 

2,547 

779 

1,272 

1,212 

480 

1*847 

913 

1,270 

403 



341, 295 



67, 637 



132 
200 
162 
174 
244 
197 
127 
155 
271 
212 
142 
243 
185 
191 
151 
188 
149 
202 
158 
155 
157 
236 
173 
161 
185 
178 
233 
222 
234 
204 
217 
248 
208 
248 
218 
150 
261 
190 
206 
162 



78.60 
38.37 
47.64 
87.99 
50.20 
73.92 
98.62 
81.22 
31.85 
54.35 

135. 67 
93.60 
53.42 

109. 87 
61.75 
83.23 
97.38 
83.43 
50.97 
42.90 
66.67 
53.13 
58.11 

124.77 
70.98 
37.41 
86.17 
72.99 

113. 47 

121.49 

100. 23 
86.46 
95.33 

113. 80 
35.25 
95.52 

103. 66 
49.38 

112. 28 
92.82 
74.80 
49.92 



80.34 



40.23 
22. 64 
36.20 
44.03 
31.05 
42.92 
40.36 
41.32 
25.06 
35.12 
50.07 
44.06 
37.69 
45.18 
33.38 
43.51 
44.59 
43.85 
34.23 
21.27 
42.26 
34.30 
37.04 
52.94 
41.07 
23.28 
46.55 
41.08 
48.65 
54.69 
43.14 
42.45 
44.14 
45.95 
16.95 
37.27 
47.44 
33.13 
43.09 
48.74 
36.38 
30.52 



44.03 



An examination of this table shows that the highest infantile death 
rate recorded for these 42 German cities is that of Chemnitz, with a 
total infantile death rate of 271 and a death rate from diarrheal 
diseases of 135.67. As Harrington points out, this latter is greater 
than the total infantile death rate of the city of Barmen (132), and 
is greater than the total infantile death rate of England and Wales 



694 

(125 in 1903), Scotland (1900-1901, 128, highest in 50 years), Nor- 
way (105, average 20 years 1874-1893), Sweden (87, 1902), Ireland 
(96.6, average 20 years 1874-1893), and is almost as high as the total 
death rate of France (137 in 1903). The average death rate from 
diarrhea in all these 42 cities was 80.34 — figures of great significance 
when Ave come to investigate the seasonal distribution and the cause 
of the prevalence of gastro-enteritis in the neonate. 

It is worthy of note that the census report of 1900 shows that in 
our country there are no less than 15 cities having a total death rate 
greater than that of Chemnitz, viz : 



Table 7. 



Charleston, S. C 419. 5 

Savannah, Ga 387. 5 

Mobile, Ala 344. 5 

Key West, Fla 311. 8 

Biddeford, Me 311. 6 

Atlanta, Ga 306.0 

Fall River, Mass 304. 7 

Lynchburg, Va 301.7 



Richmond, Va 300. 7 

Laconia, N. H 294.6 

Shreveport, La 293.5 

Jacksonville, Fla „ 287. 6 

Norfolk, Va 284.6 

Lowell, Mass 275. 5 

Washington, D. C 274. 5 



The figures in connection with the German cities concern places of 
a population in excess of 100,000, while the cities returning rates in 
this country are, many of them, considerably smaller than this. As 
Harrington points out, our methods of registration are so incomplete 
that full returns would probably indicate a condition worse than now 
is manifest, and that we have every reason to suppose, in view of the 
extreme heat of our summers, that the diarrheal death rate in this 
country forms at least as great a proportion of the total mortality as 
it does abroad. 

SEASONAL FLUCTUATION. 

Nor does the infantile death rate maintain itself constantly 
throughout the year at the same general level. On the contrary, it 
is well known that it is subject to enormous fluctuations, being ex- 
tremely high during the months of July, August, and September, fol- 
lowed by a sharp decline in the autumn. This accession to the 
infant death rate is due to the great number of deaths from diarrhea 
alone in those months, as the rate of mortality due to other infantile 
diseases remains pretty constant throughout the year. 

For example, at Leipzig, whose percentage (54.9) of deaths from 
diarrhea is higher than that of any other city in Germany, a com- 
parison of the birth rate, the infantile death rate, and the diarrheal 
death rate by months shows that in August, with an infant death 
rate of 570 to 1,000 births, 430 of these, or 75.6 per cent, were due to 
gastro-enteritis, whereas in February the total infantile mortality had 



695 

sunk to 131, of which diarrheal diseases constituted a proportion of 
only 37 to a thousand, a decrease of 1,100 per cent. 

In England the report of the registrar-general's office, compiled 
from the weekly returns of births and deaths from 76 of the largest 
cities of England and Wales in July, August, and September, 1906, 
shows that the total births for these months were 110,209, the total 
deaths under 1 year 23,058, of which no less than 14,306, or over 
50 per cent, were due to diarrhea. 

It is manifest from the foregoing that gastro-intestinal disease, 
causing as it does one-third to one-half of all infant deaths under 1 
year of age, is the largest single factor determining infant mortality. 
Further investigation demonstrates the significant fact that 75 to 85 
per cent of all infants who die of diarrhea are artifically fed. Thus 
Planchon, in investigating the relation feeding methods had to gas- 
troenteritis in Paris, shows a that, while the diarrheal death rate in 
breast-fed infants varies from a minimum of 2 per thousand in win- 
ter to a maximum of but 20 per thousand during the hot months, the 
diarrheal deaths of the artificially fed fluctuate from a minimum of 
12 per thousand in winter to a maximum of 158 per thousand in the 
summer. 

In Paris during the four summer months of 1897, 2,840 infants 
under 1 year died. Of these 1,470, or 51.7 per cent, died of diarrhea. 
Of these 1,470 who died of diarrhea, only 139 were breast fed, and 
1,331, or over 90 per cent, were artificially fed. 

The following table from Harrington (loc. cit.) illustrates ad- 
mirably this point at Berlin. The figures given cover the quin- 
quennium of 1900-1904 and relate to the incidence of deaths among 
the bottle fed and the breast fed when the method of feeding could be 
determined. 

Table 7. 





Number of 










deaths 










among in- 


Number of 


Percentage 


Percentage 


Year. 


fants under 


deaths 


of deaths 


of deaths 


1 year of age 


among 


of breast- 


among 




whose mode 


breast fed . 


fed infants. 


others. 




of feeding 










was known. 








1900 


9,558 


895 


9.36 


90.60 


1901 


9,378 
7,027 
7,680 
7,780 


856 


9.17 


90 80 


1902 


768 


10 17 


89 10 


1903 


723 


9 41 


90 59 


1904 


753 


9.68 


90 82 







Again, Helle 6 in analyzing the infantile death rate of the city of 
Graz shows that out of 170 deaths from intestinal disease in the fis- 



° Planchon: Prevalence of Diarrhea in the Artificially Fed. Obstetrique, 
January, 1900. 

6 K. Helle: Archiv f. Hygiene, 1905, VI, 18. 



696 




¥ 



Fig. 65. — Chart showing the relative mortality from gastro-intestinal disease in breast-fed 
and bottle-fed infants, 0-1 year of age, in Paris, by weeks and throughout the year. 

Breast-fed infants =■. 
Bottle-fed infants = ffl. 



697 

cal year of 1903-4 but 4 of these were breast fed, 48 were partly 
breast fed, 117 were bottle fed^ and in one case the method of feeding 
was unknown. 

Reference to Table 6 shows that the German city of Barmen, with 
an infant mortality rate of 132 (1906), enjoys the lowest rate of any 
city in Germany, and for a number of years has made a favorable 
showing in this respect. Kriege and Sentemann a attribute this for- 
tunate circumstance to the general prevalence of breast feeding in 
that city, 63 per cent of all infants being nursed by their mothers, 
15 per cent being partly breast fed, and only 22 per cent being 
bottle fed. 

Further space can not be devoted to the multiplication of figures 
showing the relative immunity of the breast-fed child to death from 
diseases of the digestive tube. Nothing, however, can more graphic- 
ally illustrate this point than the accompanying chart from Budin 
which is here reproduced (p. 696). 

PART II.— THE INFANT'S DIETARY. 

In common with adults, the infant requires five elements of food 
for its sustenance, to wit: Proteid, carbohydrate, fat, mineral salts, 
and water. Owing, however, to the undeveloped state of its organs 
of assimilation it can not avail itself of any wide dietary range. By 
reason of its rapid growth and more active metabolism it requires 
food of special form and with the nutritive ingredients in special pro- 
portions to each other. Milks are the only class of food which ful- 
fill these conditions, being, as they are, an animal product, designed 
by nature only to that end. 

As this paper deals merely with the dietary of infants less than 1 
year of age, woman's milk and its only feasible substitute, cow's 
milk, will alone be considered. 



Woman's milk is the secretion of the human mammary gland. Un- 
der normal conditions of lactation it is in no sense a transudation 
from the blood and lymphatics, but is a true secretion elaborated by 
glandular tissue. True milk is not present in the mammary glands 
until two to four days after parturition, and occasionally not until 
the fifth day. 

Colostrum. — The secretion present in the mamma for the first few 
days after delivery differs materially from normal milk and is known 
as " colostrum." It is a fluid of a deep yellow tint, chiefly due to 

°Allg. Centralblatt f. Gesundheitspflege, 1900, XXV, 25. 



698 

bodies it contains known as " colostrum corpuscles." It is not so 
sweet as milk, is strongly alkaline in reaction, of a specific gravity 
of 1.030 to 1.040, and is rich in salts and proteids. These proteids are 
of a nature similar to the proteids of the blood as they are coagulated 
by heat. Colostrum contains less sugar and fat than milk, and micro- 
scopically its fat globules vary in size and are interspersed with 
numerous bodies four or five times their size, known as " colostrum 
corpuscles." 

Composition of colostrum. — According to Pfeiffer's analysis, the 
composition of colostrum is as follows : 

Per cent. 

Proteid 5. 71 

Fat 2. 04 

Sugar 3.74 

Salts 0. 25. 

Water 88.23 

100. 00 
Caloric value per kilogram, 577.17 calories. 

The colostrum corpuscles are very abundant during the first few 
days, but under normal conditions disappear after the tenth or 
twelfth day. 

Function of colostrum. — The exact role of the colostrum is not as 
yet fully understood. We may infer from the nature of its composi- 
tion and its proteids that it furnishes to the newborn child during its 
adjustment to its novel surroundings the full expansion of the lungs 
and the awakening of the digestive processes, nourishment of a char- 
acter similar to that it received from the placenta as a fetus. That it 
serves a purpose is proven by its being the first secretion not only of 
the human breast but of that of all mammals. 

Physical characteristics of woman's milk. — With the establishment 
of lactation the breast secretes a fluid of the following physical char- 
acteristics : It is of a bluish color and marked sweetish taste. Under 
normal conditions, with the exception of some skin cocci, it is practi- 
cally sterile. These are most abundant in the " foremilk." Its spe- 
cific gravity varies from 1.026 to 1.036 (average, 1.032 at 21° C). 
Its reaction is either amphoteric or slightly alkaline when fresh. 
Dilute acetic acid merely produces a light flocculent precipitate, and 
its proteids are not appreciably coagulated by the action of rennet. 

Composition. — The exact average composition of breast milk is 
difficult to determine, as it is subject to rather wide variations between 
normal limits and at different stages during the act of being secreted. 
Thus the " foremilk " is relatively thin, the middle portion richer, 
and the " strippings " richest of all in fat content. Owing, more- 
over, to faulty methods, previous analyses of woman's milk have been 



699 

erroneous. Even now its exact composition, beyond the relative pro- 
portions of its constituents, is imperfectly understood. 

According to the most recent analyses of Pfeiffer, Koenig, Leeds, 
Harrington, Adriance, and others the average composition of human 
milk is as follows : 

Composition of woman's milk. 





Percent- 
age. 


Common nor- 
mal varia- 
tions. 


Fat 


4.00 

7.00 

1.50 

.20 

87. 30 


Per cent. 
3. 00- 5. 00 




6. 00- 7. 00 


Proteids 


1.00- 2.25 


Salts 


. 18- . 25 




89. 82- 85. 50 








100. 00 


100. 00 100. 00 



An average caloric value per kilogram, 710.5 calories ; common normal variations of 
caloric value per kilogram, 550 calories to 844.25 calories. 

Former analyses have for the most part assigned to it a higher 
amount of proteid and a lesser amount of sugar than this. The 
composition of milk is pretty nearly constant throughout lactation, 
except during the first month and toward the close. At the com- 
mencement of lactation the proteids and salts are high, and near its 
end the proteids have a tendency to diminish (Adriance). 

Proteids. — Our knowledge of the proteids of woman's milk is still 
incomplete. The most important proteid substances, however, are 
casein and lactalbumen. Some investigators mention a third, lacto- 
globulin. The casein is in chemical combination as calcium casein, 
and owing to its relative proportions to the other proteids is only 
slightly precipitated by dilute acids and not appreciably coagulated 
by rennet. 

The lactalbumen is believed to be similar to serumglobulin. 

The proportions of lactalbumen to casein have not been definitely 
agreed upon, but it exists in far greater proportions relative to the 
casein than in cow's milk. According to Koenig, the relative propor- 
tions are as 5 to 4. The total amount of proteids varies normally 
from 1 to 2 per cent and abnormally from 0.07 to 4.5 per cent. They 
are highest during the first few days of lactation ; after the first few 
weeks they vary but little until toward its end, when they experience 
a decided decrease. 

Fat. — Fat is present in woman's milk in the form of minute glob- 
ules, and in perfect emulsion by virtue of the albuminous fluid in 
which they are suspended. It exists mainly in the form of the neu- 
tral fats, olein, palmitin, and stearin, and but small quantities of 



700 

the fatty acids are present. Forty-three analyses by Leeds show vari- 
ations in the fat content of woman's milk of between 2.11 and 6.89 
per cent, with an average of 4 per cent. The percentage of fat pres- 
ent in woman's milk is but little affected by the period of lactation. 

Sugar. — Sugar is the most constant of the ingredients of human 
milk in its percentage. It is present as lactose in complete solution 
in the proportions of from 6 to 7 per cent. Its quantity is least in 
the first week. After the first month its variations are very light. 

Salts. — Only one- fourth as much inorganic salts is present in 
woman's milk as in cow's milk, and, with the exception of the cal- 
cium in combination with the casein, are all in solution. They are 
present in the proportion of 20 per cent. 

CLINICAL EXAMINATION OF WOMAN 's MILK. 

It is often of importance to recognize the occurrence of quantita- 
tive and qualitative departures from the normal composition of 
woman's milk occurring during lactation, and their nature, as upon 
them are dependent many nutritional disturbances of the nursing 
child. 

The most common abnormalities to be recognized are (a) disturb- 
ances in the quantity and (b) disturbances in the quality of the lac- 
teal secretion. 

According to the researches of Haehner, Feer, Huebner, Laure, 
Ahlfeld, and others, the average daily quantity of milk drawn by 
infants of different ages is as follows: 

Ounces. 
At end of first week, 300 to 500 grams 10 to 16 

During second week, 400 to 550 grams 13 to 18 

During third week, 430 to 720 grams 14 to 24 

During fourth week, 500 to 800 grams 16 to 26 

From fifth to thirteenth week, 600 to 1,030 grams 20 to 34 

From fourth to sixth month, 720 to 1,150 grams 24 to 38 

From sixth to ninth month, 900 to 1,220 grams 30 to 40 

The average daily amount of milk per kilo of body weight drawn 
by the child was found to be as follows: 

Ounces. 

During first three months, 150 cubic centimeters 5 

During second three months, 140 cubic centimeters 4f 

During third and fourth three months, 120 cubic centimeters 4 

It was also found that the total daily amount drawn corresponds 
very nearly to the following figures in proportion to the body weight 
of the child : 

First three weeks, one-fifth of body weight. 

First month to end of sixth month, one-sixth to one-seventh of body weight. 

Last half of first year, one-eighth of body weight. 



701 

The daily quantity of the milk drawn from the breast by the child 
is best determined by weighing the child before and immediately 
after each feeding during the entire twenty-four hours for severak 
days. An accurate set of scales, sensitive to 15 grams (|- ounce) should 
be used. By computing the sum of the weights of the separate feed- 
ings for each day and striking an average for the daily amounts 
during the period of observation, the average amount of the daily 
consumption of milk can then be determined. As children vary in 
age, weight, and nutritive needs, the figures obtained will only be of 
value when compared to the body weight and age of the child that 
received them, as is subsequently to be discussed. 

Reaction. — This may be tested by litmus paper and should be 
alkaline or amphoteric, never acid. 

Specific gravity. — This may be determined with the aid of any 
small hydrometer, such as a urinometer with a scale registering from 
1,010 to 1,040. The specific gravity is lowered by fat, but increased 
by the other solids. 

Microscopical examination. — Besides the fat globules, the micro- 
scope may reveal the presence of colostrum corpuscles, blood, pus, 
epithelial cells, bacteria, and granular detritus. The presence of colos- 
trum corpuscles is abnormal after the twelfth day of lactation. Blood 
and pus are always abnormal. The presence of blood and pus in the 
milk require the suspension of lactation until they disappear. 

Determination of fat. — The simplest method of determining the fat 
of woman's milk is by Holt's cream gauge. This is a graduated tube 
on a foot, with a glass stopper. The tube is filled with freshly drawn 
milk to the zero mark at the top of the scale and the whole allowed 
to stand at room temperature for twenty-four hours. The percentage 
of cream according to the scale is then read off. The ratio of the 
cream to the fat content is as 5 : 3 ; e. g., 5 per cent of cream equals 3 
per cent of fat, etc. 

While not very accurate, this method suffices for clinical purposes. 
Results approximating the accuracy of a chemical analysis may be 
obtained by the Babcock test or by Lewis's modification of the Leff- 
man and Beam test for cow's milk (Holt). This is a centrifugal test 
for which special tubes are required, which, however, may be used in 
the ordinary centrifuge for urine. 

Sugar. — The percentage of sugar in human milk is subject to very 
little variation, and may be regarded as constant for clinical pur- 
poses. 

Proteids. — The determination of the proteids in woman's milk is an 
elaborate process requiring the resources of a well-equipped chemical 
laboratory. 

We may, however (according to Holt), gain an approximate idea 
of their percentage by considering the sugar and salts of milk as con- 



702 

stants not affecting its specific gravity, and estimating the proteids 
from our knowledge of the fat content of the specimen. Now, the 
specific gravity will vary directly with the proteids and inversely to 
the fat, viz, high proteids, high specific gravity; high fat, low spe- 
cific gravity. The following table shows the application of this 
principle : 

Variations in the composition of woman's milk as deduced by observation of 
the specific gravity and the fat content (Holt). 



Specific gravity, 70° F. 



Cream, 24 hours. 



Proteids, estimated. 



Average 

Normal variations. . . 
Normal variations. . . 
Abnormal variations 

Abnormal variations 
Abnormal variations 

Abnormal variations 



1,031 

1,028-1,032 

1,031 

Low (below 1,028) . 

Low (below 1,028) . 
High (above 1,032 ) 

High (above 1,032) . 



7 percent 

8-12 per cent 

5-6 per cent 

High (above 10 per cent) 

Low (below 5 per cent) . . 
High 

Low 



1.50 per cent. 
Normal (rich milk). 
Normal (fair milk). 
Normal or slightly 

below. 
Low (very poor milk) . 
Very high (very rich 

milk). 
Normal or nearly so. 



As the milk drawn from the breast during the first part of nursing 
is richer in proteids and much poorer in fats and the last portion 
rather poorer in proteids and rich in fats, the entire amount of milk 
present in the breast should be drawn off for the purpose of this esti- 
mation. 

COW'S MILK. 

Cow's milk is the only food supply, apart from mother's milk, 
available in this country, from a practical standpoint, for the nourish- 
ment of infants under 1 year of age. It forms besides a large part of 
the dietary of older children and of many adults. It is consequently 
of the utmost importance, in view of its perishability, that it should 
only be used as a food under conditions which will insure its whole- 
someness. 

We have already considered the enormous loss of life occurring 
among the artificially fed infants, of which the larger part is un- 
doubtedly due to bad milk and its improper use as an article of diet. 

Stated as a general proposition, the following conditions should be 
fulfilled in milk that is to be used as a basis for the nourishment of 
young infants : First, it should be clean ; second, it should be fresh ; 
third, it should be whole (i. e., not falsified by additions or subtrac- 
tions of its component parts or by the addition of preservatives) ; 
fourth, it should be free from pathogenic organisms and toxic prod- 
ucts ; and fifth, it should be kept cold. 

Importance of clean milk. — By clean milk we understand a milk 
which has been collected under such hygienic conditions from healthy 



703 

animals and handled under such precautions as to insure its reach- 
ing the consumer without containing any visible particles of ex- 
traneous matter as well as any excessive number of bacteria. 

Unfortunately, whenever the milk supply of a community has been 
investigated, either under public or private auspices, the conditions 
found to prevail in the production and handling of milk have always 
been disappointing, if not, as in many instances, revolting to the last 
degree. The insanitary surroundings and general condition of filth 
23re vailing at some dairy farms is at times indescribable, and the ex- 
amination of milk produced under these conditions reveals not only 
a bacterial flora, but a degree of contamination with gross particles 
of extraneous matter such as to suggest utter carelessness or ignorance 
on the part of the producer. 

Milk when produced under such circumstances not only contains a 
plentiful enrichment of dust, dirt, dung, cow hairs, flies, and other 
foreign bodies, but also a bounteous inoculation of bacteria of all 
forms, such as may render it from the very outset unfit for human 
consumption. 

Significance of a large bacterial content in milk. — While many of 
the numerous varieties of bacteria encountered in milk are of a harm- 
less character, their presence in large numbers is always evidence 
of either milk carelessly handled or milk improperly cooled and 
kept. The presence of gross contamination with the foreign mat- 
ters previously enumerated insures the planting of the bacteria of 
putrefaction and decomposition. Such milk, without suffering any 
material change in its taste or physical appearance, may contain the 
poisons of bacterial activity to a dangerous extent. No universal 
standard has as yet been settled upon as to what constitutes an excess- 
ive degree of bacterial contamination of milk. In general it has 
been agreed that for milk sold from cans, anything less than 100,000 
to the cubic centimeter is good; for milk sold in bottles, anything 
under 10,000 must be considered especially good. Yet it is possible 
by the exercise of especial care to produce a milk which the year 
round when delivered to the consumer will have an average bacterial 
content of less than 5,000 to the cubic centimeter. Milk from high- 
grade dairies, when sold in bottles, usually averages from 10,000 to 
100,000 bacteria, while milk sold from cans may range anywhere from 
100,000 to 40,000,000, especially in hot weather. 

Fresh milk. — By fresh milk, we understand milk less than twenty- 
four hours old when delivered. Under the ordinary conditions pre- 
vailing in the handling of milk it will have undergone such fermenta- 
tive changes as to render it unfit for the use of young children after 
the expiration of this period. The special conditions of care in the 
production of milk which render it safe after a longer time than 
this are unfortunately very far from prevalent. 



704 

Infected milk. — Infected milk is milk contaminated with patho- 
genic germs. Very many instances have been and are still being ad- 
duced of epidemics of the zymotic diseases, such as typhoid fever, 
scarlet fever, diphtheria, and the like, which have been directly 
traced to milk contaminated with their specific bacilli. Such epi- 
demics originate either in the water supply of the dairy farm or from 
sickness among the personnel engaged in handling it. Pathological 
conditions affecting the cow are also contributive to the infection of 
milk. Thus tuberculous disease of the udder is a fruitful source of 
the presence of the bacillus of tuberculosis, and garget, an inflamma- 
tion of the bovine mammary gland, is a very common cause of the 
presence of pus and streptococci. In short, unless conditions affect- 
ing the water supply, the dairy farm, the health of the cattle, and 
the incidence of disease among the employees engaged in handling it 
from the cow to the consumer are subject to efficient prophylaxis, so 
long will conditions favorable to the infection of milk obtain. 

Falsification of milk. — It is obvious that milk should be what it 
purports to be, i. e., whole milk. It should, therefore, not be robbed 
of its content of butter fat by skimming, nor should its color be im- 
proved by artificial means. It is needless to say that no preservatives 
should be added to it, as is often done by the unscrupulous. 

Cold milk. — The prompt cooling of milk, after it is drawn, to a 
temperature of 7.7° C. (45° F.) and its maintenance at that temper- 
ature until the time of consumption is one of the most efficient means 
at our command for restraining the growth of its bacterial content 
and preserving its wholesomeness as a food. Milk is an excellent 
culture medium for bacteria. Although by appropriate precautions 
the number of germs present can be very materially reduced, there 
are no methods at present commercially possible by which the nat- 
ural sterility of mother's milk as drawn by the babe can be imitated. 
It is entirely within our means, however, to restrict the growth of 
bacteria in milk. 

The rapid cooling of cow's milk after it has been drawn to a tem- 
perature of 7.7° C. (45° F.) and the maintenance of that tempera- 
ture until the time of consumption not only prevents the multipli- 
cation of its original bacterial content, but actually tends to diminish 
their number. In the winter, the low atmospheric temperature ren- 
ders this easy of accomplishment. In the summer, the fulfillment of 
these conditions involves the use of efficient methods of refrigeration 
on the part of the dairyman, the transportation company, the milk 
jobber or handling company, and finally on the part of the consumer 
to whom the milk is delivered. 

It is the preliminary seeding of milk with the noxious germs of 
filth and their deliberate and luxuriant cultivation by conditions of 
temperature both of the milk and its surroundings, often simulating 



705 

that of a laboratory incubator, which is one of the chief causes of 
the high degree of diarrheal mortality during the summer months 
of the infants to which it is fed. Instead of the phrase " milk warm 
from the cow," so common in popular literature, we must substitute 
the words " milk cold from the cow " and see to it that they become 
an actuality. 

COMPOSITION OF COW'S MILK. 

The composition of cow's milk from different breeds varies chiefly 
in the content of butter fat, the other ingredients being remarkably 
constant in their proportions. Holstein cattle produce milk with 
the lowest fat content (3 per cent) and Jersey cattle that with the 
highest (5 per cent). According to the analyses of Richmond, 
Fleischmann, United States Experiment Station, Adriance, and 
others, good herd milk has the following average composition : 

Average herd milk of good quality. 

Per cent. 
Fat 4.00 

Proteids 3.50 

Salts .75 

Sugar 4. 50 

Water 87.25 

100.00 
Caloric value per kilogram, 700 calories. 

Physical characteristics of cow's milk. Its color is white, varying 
from a clear to a yellowish white. It is very opaque, the opacity 
being due to its large content of calcium in combination with its 
casein. Its specific gravity varies from 1.028 to 1.033, with an aver- 
age of 1.031. Its taste is pleasant and characteristic. The addition 
of acetic acid causes a flocculent precipitate, and on the addition of 
rennet it coagulates into a firm mass. 

Reaction. — When fleshly drawn this is amphoteric or slightly 
alkaline ; on standing it soon becomes acid. 

Proteids. — The proteids of cow's milk consist mostly of casein in 
combination with calcium. As in woman's milk, lactalbumen is 
also present but in small quantity. According to Koenig, casein is 
present in the proportion of 7 to 1 as compared to lactalbumen. 

Fat. — The fat in cow's milk is the element that is most subject to 
variation, as the content of the other food elements is remarkably 
constant. A milk poor in butter fat contains about 3 per cent, while 
a rich milk, such as milk from Jersey cows, contains 5 to 5.25 per 
cent of fat. It is highly important to know the percentage of fat 
present in milk actually being used for the feeding of infants, for 
reasons discussed later on. 

45276°— Bull. 56—12 45 



706 

The sugar of cow's milk is practically identical with that of 
woman's milk^ and is present in the proportion of about 4.50 per 
cent. 

Salts. — Inorganic salts are present in the proportion of 0.75 per 
cent, of which calcium and phosphoric acid are the most abundant 
constituents. 

Bacteria. — Cow's milk always contains a large number of bacteria, 
their number increasing with the age of the milk and the conditions 
under which it is kept. 

Cream-. — Cream is merely cow's milk rich in fat to excess. It is 
obtained either by skimming the milk (gravity cream) or is separated 
from it centrifugally by a machine known as a separator. It differs 
from milk but slightly in its other solids. Very rich cream (40 per 
cent) contains relatively less sugar and proteid (sugar 3 per cent, 
proteid 2.20 per cent). The usual strengths of separated creams 
marketed contain respectively 8 per cent, 12 per cent, 16 per cent, 20 
per cent, and 40 per cent of fat. 

PART III.— INFANT FEEDING. 
NUTRITIVE REQUIREMENTS OF INFANTS. 

It is obvious that any inquiry into the methods of infant feeding 
demands an intelligent comprehension of their nutritive requirements. 
Yet this phase of the question has been the object of scientific study 
only of recent years. Why this has been so, it is difficult to under- 
stand, seeing that we have long been possessed of very precise data 
as to the calorific value of the various articles composing the adult's 
dietary and the amount of heat units required to maintain their 
nutrition under various circumstances. And yet, until the investi- 
gations of Heubner and his co-workers, our knowledge of the nutri- 
tive needs of infants has been mainly empirical and based merely on 
clinical observations, observations which I may add have been the 
source of serious error. 

The world is indebted to O. Heubner of Berlin, who was the first 
of a series of investigators, now rapidly increasing, for the discovery 
of facts which go a long way toward solving the difficult problem of 
infant feeding. Heubner , a appreciating that the principles underly- 
ing the feeding of infants, could only be worked out, as in the case of 
adults, from the logical basis of the number of calories per kilogram 
of body weight required by them for the purposes of growth and 
nutrition, undertook a series of exhaustive experiments with this end 
in view. 

° O. Heubner, Die Energiebilanz des Sauglings. Zeitschrift f . diatet. u. physik. 
Therapie, 1901, Vol. V, p. 13. 



707 

Like most fundamental investigations, his line of procedure was 
quite simple, being merely to determine the daily amounts nursing 
children took at the breast, each day for successive months, to tabulate 
the daily and weekly gains observed, and finally to determine by 
chemical analysis the composition, and from that the calorific energy 
of the milk that produced it. 

His results show that^ on the average, nursing infants, in order to 
thrive, require the following food value, or energy quotient as he 
calls it, per kilogram of body weight : First week in life, 60 calories ° 
per kilogram of body weight; first three months, 100 calories per 
kilogram of body weight ; second three months, 100 to 90 calories per 
kilogram of body weight ; third and fourth three months, 80 calories 
per kilogram of body weight. 

His results were confirmed b}^ Feer, Nordheim, Beutner, Czerny, 
Keller, and others. He also found that an energy quotient of 70 was 
the minimum on which a child of less than 1 year of age could 
maintain its weight. Any diminution of the quotient below this 
level was followed by a loss. Moreover, the researches of Czerny and 
Keller & have shown that the energy quotient of 100 calories per 
kilo of body weight marks an upper limit which can only be tem- 
porarily surpassed without inducing disastrous nutritive and gastro- 
intestinal disturbances. These disturbances will be later discussed 
under the head of " overfeeding." 

A necessary part of these researches was the determination of the 
caloric value of mother's milk. As human milk varies in composi- 
tion, not only in different individuals but at different stages of its 
secretion from the breast, only average values could be found. Ac- 
cording to the richness of the milk, it varied from 614.2 to 723.9 when 
lactation was fairly established with an average caloric value of 650 
to the kilogram. 

The determination of the caloric value of any food substance is 
very easy once we know its percentage composition as one gram of fat 
produces 9.3 calories and one gram of proteid, and one gram of car- 
bohydrate have each a caloric value of 4.1. 

Thanks to these investigations we are now in a position to deter- 
mine most exactly, if desired, the amount of food required by each 
individual child in order to nourish it and give it growth and have, 
furthermore, data by which we determine whether it is getting too 
much, in time to avert the disastrous consequences. 

a This term, as used in this paper, refers to large calories, or the amount of 
heat requisite to raise 1 kilogram of water 1° C. in temperature. 

*> Czerny and Keller, Des Kindes Ernahrung, Ernahrungsstorungen und 
Ernahrungstherapie. 



708 



METHODS OF FEEDING INFANTS. 



There are three methods by which infants may be fed : (a) Maternal 
nursing, (b) mixed feeding, part maternal and part artificial, and 
(c) artificial feeding exclusively. 

MATERNAL NURSING. 

Importance of maternal nursing. — The importance of maternal 
nursing can not be overestimated. Were mothers able universally to 
nurse their children, one-third to one-half of infant deaths would be 
expunged from our mortality returns. 

The number of women capable of nursing their children is prob- 
ably greater than is supposed. Von Bunge's® statistics, gathered 
from all parts of Europe, tend to show that probably 75 per cent of 
all women could nurse their children. I have already adverted to the 
German city of Barmen, where 63 per cent of all infants are fed at 
the breast. Professor Budin's h statistics of the Clinique Tarnier in 
Paris show that 448 out of 557 women who attended were able to 
nurse their children. The importance of maternal nursing is well 
recognized in France, both by the Government and by commercial in- 
terests. The effect of this encouragement upon public sentiment has 
been marked, and in some of the industrial districts of France where 
formerly the artificial feeding of infants was the rule it has now 
become the exception. 

In most of the factories of that country employing women, notices 
are conspicuously posted setting forth the advantages of maternal 
nursing. In many of these establishments rooms are set apart 
wherein mothers nurse their children, and they can always obtain 
leave of absence at appropriate intervals for the purpose of suckling 
their infants. 

In Italy a law has been passed compelling each industrial establish- 
ment employing 50 or more women to furnish rooms for this purpose. 

Causes preventive of maternal nursing. — Three causes are mainly 
operative in depriving infants of their right to the breast. First, 
physical inability on the mother's part to nurse her child; second, 
inability on her part by reason of her engagement in some industrial 
pursuit; and third, disinclination, chiefly by reason of the trouble 
maternal nursing involves and the divorce it necessarily entails from 
social pleasures and pursuits. 

Von Bunge has shown that apart from local and systemic disease, 
alcoholism seems to be the chief cause, in any country as a whole, 
which renders mothers as a class unable to nurse their children. The 

a Von Bunge, Die zunehmende Unfahigkeit der Frauen ihrer Kinder zu stillen. 
* Budin " The Nursling." 



709 

daughters of the third generation of alcoholics are usually unable to 
suckle their young. 

The second condition referred to, i. e., the engagement of the 
mother in some industrial pursuit, depends in a great measure upon 
the willingness of husbands to accept the earnings of their wives at 
the expense of their children, or upon their failure to provide for 
them. This forces the mother to work for her bread while her child 
is turned over to the tender mercies of some stranger and the milk 
bottle. 

Much can be done by general popular enlightenment to eliminate 
the third cause, namely, the disinclination of mothers to nurse their 
children. It is hardly to be supposed that any woman will refuse to 
nurse her baby from purely selfish considerations, once she is fully 
informed of the enormous advantages it confers upon her child. It 
is obviously the duty of the medical profession to further this end 
by every means at their command. 

In view of the foregoing, every mother should nurse her child un- 
less there are cogent reasons to the contrary. The following causes 
may be mentioned as contraindicating maternal nursing: 

(1) Tuberculosis, latent or active, affecting the mother. By nurs- 
ing the child she can but accelerate the progress of the disease, besides 
exposing the child to the danger of contracting it. 

(2) When the mother is affected by grave, chronic, or systemic 
disease. 

(3) When the mother is choreic or epileptic. 

(4) If she has suffered from any severe complication of the partu- 
rient state, such as hemorrhage, eclampsia, nephritis, puerperal septi- 
caemia, and the like. 

(5) Local disease of the mammary gland. 

(6) When as the result of two previous experiences under favor- 
able conditions she has shown her inability to nurse her child (Holt). 

(7) When no milk is secreted. 

Care of the breasts during lactation. — In order to prevent local af- 
fections, both of the mammary gland and the infant's mouth, it is 
highly important that particular attention should be paid to cleanli- 
ness. The nipples and breasts should, therefore^ be carefully washed 
prior and subsequent to nursing, either with plain water or boric-acid 
solution. 

Nursing during childbed. — A newborn child should be nursed once 
in six hours the day following delivery and once in four hours the 
succeeding day. This is necessary (1) to accustom the child to take 
and the mother to give the breast, (2) to empty the breasts of colos- 
trum, (3) to promote the involution of the uterus. 

The colostrum furnishes the child with all the calories necessary 
to its needs until the lacteal flow is established, nor does it need any 



710 

other food. The usual practice of feeding a newborn child with de- 
coctions of various sorts with the object of alleviating the colic sup- 
posedly indicated by its cries is absolutely to be prohibited. The cry- 
ing promotes the full expansion of the lungs and the establishment of 
normal circulation. Plain boiled water, however, may be freely 
given, as the body fluids of the newborn are in a concentrated state. 

Regular habits of nursing. — Much more is dependent upon the 
early establishment of regular nursing habits than is supposed. 
They are as easy to initiate as the irregular, and by so doing much of 
the strain of lactation upon the mother can be eliminated. This is 
highly desirable in view of the beneficial effect a calm and equable 
state of mind and adequate time for rest and sleep have upon the 
lacteal secretion. Moreover, the milk is more likely to be of a uni- 
form character throughout lactation when the breasts are drawn 
upon at intervals definitely spaced. A young infant can usually 
be expected to take a long nap of some four or five hours during 
some period of the twenty-four, and it is just as easy to have this 
secured at night. In order to promote the uniformity of lacteal secre- 
tion necessary to regular growth, the intervals between nursing 
should not be too short. Nor, on the other hand, in the earlier 
months at least, should they be too long. In the first instance, the 
milk is apt to be too rich and concentrated (Rotch), thus causing 
overfeeding, and in the second, it is apt to be deficient in nutritive 
elements. Huebner is of the opinion that the number of nursings in 
the twenty-four hours usually advocated is too great, and a less num- 
ber is productive of better results. In this view he is confirmed by 
Czerny, Keller, and others. 

The following schedule seems to fulfill the best practice in this 
direction : 



Age. 



Number of 

nursings 

in 24 hours. 


Interval 

during 

day. 


4 


6 


6 


4 


8 


2f 


7 


3 


6 


3 


5 


4 



Night. 



First day 

Second day 

Third to twenty-eighth day 
Fourth to thirteenth week 

Third to fifth month 

Fifth to twelfth month 



It may not always be possible to carry this schedule into effect, but 
every effort should be made to do so. In the majority of cases, how- 
ever, no difficulty will be experienced, provided the child be always 
awakened, if necessary, when the time comes to put it to the breast. 
Regularity in nursing intervals is of great assistance to the mother 
in providing for her adequate recuperation, and the unbroken sleep 



711 

at night permits her to continue lactation long after the time she 
would otherwise have to abandon it. 

Mode of giving the child the or east. — It is surprising to note the 
ignorance of some mothers even in such essential details as this. It 
is, therefore, necessary to see that the breast is properly presented to 
the child. The child should be held in such a position that it can 
seize squarely upon the nipple, which should not be presented ob- 
liquely to it. It is important to avoid pressing the child's nose into 
the breast, in order to allow it free respiration. 

Signs of successful breast feeding. — The child who is receiving 
adequate nourishment from the breast performs all its functions with 
the optimum of regularity. Its sleep is peaceful, its appetite is keen, 
and it presents a general appearance of contentment and bien etre. 
The bowel movements are free, and consist of two or three golden, 
smooth, salve-like discharges a day. The urine is odorless, limpid 
and adequate in amount. The body tissues are firm and elastic, and 
their outlines plump and rounded. Most important of all, the child 
gains steadily and constantly in weight. If an infant cease to gain 
in weight something is always wrong. On the other hand, sudden 
and abnormal gains in weight point to excessive overfeeding, and re- 
quire a reduction of the nourishment in amount. 

After the initial loss following birth has been regained, the average 
healthy child increases in weight during the first three months from 
120 to 150 grams (4 to 5 ounces) every week and from the third to the 
sixth month from 100 to 120 grams (3^ to 4 ounces). The effect of 
these increases is to double the initial weight at six months, and to 
treble it at the close of the first year. Large children gain absolutely 
but not relatively greater weekly amounts than the small. This rate 
of gain may be considerably increased within physiological limits, 
the main indication of abnormality being a wide departure from a 
rate of gain previously observed. To this end infants should be 
regularly weighed on sets of scales sensitive to 15 grams (-J ounce). 
A careful record of the weight should be kept. 

Signs of inadequate nursing. — The early detection and diagnosis 
of abnormalities in the quality and quantity of the milk furnished 
by the mother is imperative; for, unless corrected, they are fraught 
with danger to the child. While nothing can take the place of good 
natural nursing, and while poor artificial feeding is the very worst 
method of infant nutrition we have, poor maternal nursing is an 
inferior alternative to good artificial feeding. We should, there- 
fore, endeavor to discover the difficulty as soon as possible in order 
that hasty weaning of the child should not take place when the 
symptoms are unconnected with the food, or the indigestion from 
which it is suffering is due to causes temporary or remediable. On 
the other hand it is obvious that, if from every symptom maternal 



712 

nursing is going to fail, it should not be allowed to continue because 
the mother desires it from mistaken notions of her duty to the child. 

Inadequate nursing, insufficiency. — During the first few days of 
life the temperature of the child furnishes a very important indica- 
tion, not so much of the nourishment as of the amount of fluid it is 
receiving. Very few children who are receiving a sufficient quantity 
of fluid from the breast during the first few days of life present ab- 
normalities in the temperature. 

Fever of inanition. — Many of those who get little or nothing dur- 
ing this time have an elevation of temperature of 38.4° to 39.1° C. 
(101° to 102° F.), while in exceptional cases the temperature rises to 
40° or even 41° C. If no other obvious symptoms of disease are 
present, such a temperature observed on the second to the fourth day 
may be considered evidence of insufficient ingestion of fluid or even 
of starvation. Supplying the needs of the infant in this respect 
rapidly causes a disappearance of the fever. 

If the milk of the mother's breast be insufficient to supply a greater 
energy quotient than 70, the child ceases to gain in weight; if below 
this, a loss ensues. The child is fretful and seems always hungry, as 
indicated by continuous sucking of the fingers and remaining a long 
time (forty or fifty minutes) at the breast. If it stops then, it is 
rather from exhaustion than because it is satisfied. If the insuffi- 
ciency of food has been very great from the outset, it may lie in a 
remarkable condition of apathy (Budin), sleeping most of the time. 
Weighing the child before and after nursing shows that it gets very 
little. The mother's breasts are not full and tense at nursing time, 
as they should be, and during the intervals of feeding but little milk 
is present in them. The child's discharges, both fecal and urinary, 
are very small, and, most important, there is a steady loss in weight. 

Inadequacy of maternal nursing {overfeeding). — This is not so fre- 
quently seen in children at the breast as in those artificially fed. It is 
mainly observed in the case of strong, full-blooded mothers or wet 
nurses, whose milk from rich food and insufficient exercise is highly 
charged with fat. Overfeeding is briefly characterized by the fol- 
lowing sysmptoms, the cause of which will be discussed in another 
connection: They are irritability, restlessness, and broken sleep, fol- 
lowed by constipation with gray, dry stools. The urine is odorous 
and stains the diaper. A continuance of the cause finally induces 
severe gastro-intestinal symptoms ; vomiting and diarrhea are present, 
with discharges containing curdy masses of fatty soaps. The gain in 
weight diminishes, ceases, or a loss is manifest. 

Value of the examination of the breast milk when the infant is not 
"doing well." — In many cases when the child is not thriving an ex- 
amination of the breast milk may give valuable information. I have 
given elsewhere clinical methods by which an approximate idea of 



m 

its qualities may be obtained. The result of the milk examination 
usually discloses ( 1 ) that it is too rich in quality and unusually abun- 
dant in quantity ; (2) that it is scanty and poor in quality ; (3) that it 
is abundant, but poor in quality. 

Over-rich milk. — I have already adverted to this condition and 
the gastro-intestinal disturbances it may induce. Clinically, over- 
rich milk is indicated by a high specific gravity (1.032 to 1.036), 
combined with a high percentage of fat. The child should not be 
weaned, but the quality of the milk regulated by less frequent nurs- 
ings, a simple diet, and exercise in the open air to the point of mod- 
erate fatigue. As the symptoms in the child are caused by the con- 
tinuous ingestion of a food far superior in caloric value to his 
nutritive needs, the diminished frequency of the nursings not only 
enables it successfully to rid itself of the excess of nutrient elements 
ingested, but also tends to diminish the richness of milk secreted. 

Scanty milk of a poor quality. — This condition is most frequently 
manifest in delicate and anaemic mothers. The amount present in 
the breast may be so small that the small quantity of milk necessary 
to make the examination is secured with difficulty. The clinical 
characteristics of this milk are low specific gravity (1.024 to 1.027) 
and cream only 2 to 4 per cent. In such cases the quality of the 
milk is so poor and the quantity so small that it is manifestly im- 
possible to nourish the child by it. 

In other instances the variation from the normal is not so great; 
i. e., specific gravity 1.028 to 1.030, cream 4 per cent, with fairly 
abundant quantity. In such cases we may hope to improve the 
quality of the milk by appropriate measures. These are adequate 
rest for the mother at night, fresh air, nourishing food, and gentle 
exercise. The anaemia usually present may be improved by malt 
extracts and preparations of iron. If this condition is dependent 
upon conditions incidental to the lying-in period, the outlook is 
usually good. If, on the other hand, it is the result of constitu- 
tional debility or neurotic diathesis, improvement may only be tem- 
porary, necessitating the weaning of the child, not only in its own 
interests, but those of the mother as well. 

Abundant milk of poor quality. — This condition is sometimes seen 
in anaemic subjects who have been taking large quantities of malt or 
alcoholic beverages in the hope of improving their milk supply. In 
such cases the quantity may be so abundant that the breasts are pain- 
fully full at nursing times and between them may flow away sponta- 
neously. Clinical examination shows low specific gravity and very 
low fat. 

Owing to the grade of hydremia accompanying these conditions, 
very little improvement can be expected to ensue from treatment, and 
nursing should be discontinued. 



714 

Wet nursing. — The milk of another healthy woman is the best sub- 
stitute for maternal nursing when the mother's supply has failed. 
Expense and the difficulty of obtaining a good wet nurse in this 
country are countervailing circumstances. The wet nurse should be 
a perfectly healthy woman free from syphilis or tuberculosis. A 
careful physical examination should be made to ascertain these points. 
Her breasts should be well developed and at nursing time be tense and 
full. A good amount of glandular tissue should be present in the 
breast and pains taken to be assured of that point. The nipple 
should be of normal development and free from cracks or fissures. 
Her blood should be rich, as it is impossible for an anaemic woman to 
give good milk. 

Contrary to what is usually supposed, it is by no means necessary 
that her milk should correspond in age to that of the child. She 
should, however, have been a nursing mother long enough to be able 
to demonstrate by the condition of her child that she has plenty of 
good, nutritious milk. To this end her child should always be in- 
spected before her acceptance. When accepted she should be given 
a fair chance to adjust herself to her novel surroundings before decid- 
ing her incompetent as a nurse, as these conditions may, at. first, 
notably affect her supply of milk. 

Weaning. — The time at which weaning should take place is sub- 
ject to considerable variations. With an abundant supply, nursing 
may usually be continued to advantage during nine or ten months of 
the first year. Some mothers are able to extend this period through 
the twelfth month. After that time breast feeding is seldom advis- 
able. As a usual thing, the ninth month marks the time when the 
breast must be supplemented by other food. 

Method of weaning. — Weaning should be gradually done, both in 
the interests of the mother and the child. Much of the difficulty at- 
tending the gradual weaning of infants may be eliminated by accus- 
toming the child to take a bottle from the outset. This may be ac- 
complished by feeding it boiled water from a bottle from the begin- 
ning. In the absence of such measures the experience is too frequent 
that the child refuses all other food as long as it has access to the 
breast, and nothing short of actual starvation will induce it to accept 
either the bottle or the spoon. 

Weaning during the hot months should be postponed if possible; 
but the harm thus done is not usually so great as the continuance of 
the child on an inadequate breast milk. 

Indications for sudden weaning. — Sudden weaning may be neces- 
sary at any time on account of the development in the mother of se- 
vere acute disease, such as typhoid fever or pneumonia; of grave 
systemic disorders, as tuberculosis or nephritis; from the intercur- 
rence of pregnancy or of disease of the mammary gland. Minor ill- 



715 



nesses or acute sickness of short duration are not indications for 
weaning, though if the attack be severe the infant may be placed 
temporarily on the bottle, and the flow of milk maintained by the 
breast pump. Upon the establishment of convalescence, the infant 
is returned to the breast. 

Mixed feeding. — This is a combination of breast and artificial feed- 
ing. It is useful when the mother's milk is good but somewhat defi- 
cient in quantity. It may also be adopted when it is evident that the 
strain of maternal nursing is making inroads on the mother's reserve 
of health. She may then be relieved to the extent of one or two 
nursings a day, and thus considerably prolong the period of her lac- 
tation. Mixed feeding is also useful as an expedient to bridge over 
temporary insufficiency in the mother's supply of milk. It is not 
expedient, however, to reduce the maternal nursings by three or more 
a day, lest the mother suffer a serious deterioration in the quality of 
her milk. 



ARTIFICIAL FEEDING. 



In considering the artificial feeding of infants, there are several 
general principles which have received universal acceptance : 

First. That as mother's milk is an ideal food, supplying the infant 
with proteid, fat, and carbohydrate in proportions adapted to its 
needs, the only logical substitute is a food that will do the same. 

Second. The substitute should approximate mother's milk (a) in 
the energy quotient that it furnishes, (b) in proximate principles, 
and (c) in the amounts necessary to maintain nutrition. 

Third. These conditions are secured only by some animal milk. 

While infants have been sucessfully fed on the milk of other do- 
mestic animals, such as the goat, the horse, and the ass, cow's milk is 
the only substitute commercially and practically available in this 
country as a food for the artificial feeding of infants less than 1 year 
of age. 

Comparison of cow's milk and woman's milk. — In order to proceed 
with intelligence it is necessary to compare the average composition 
of woman's milk with cow's milk. The following table shows the 
difference between their average composition: 





Woman's 
milk. 


Cow's 
milk. 


Fat 


Per cent. a 

4.00 

1.50 

7.00 

.20 

87. 30 


Per cent. a 
3.00 


Proteid 


4.50 


Sugar 


4.50 


Salts 


.75 


Water 


87.25 








Calories per kilo 


100. 00 
710. 50 


100. 00 
700. 00 








"Average. 







716 

Cow's milk is more opaque than woman's milk, although woman's 
milk may contain a greater percentage of fat. This is due to the 
greater content of calcium salts in cow's milk by reason of its greater 
proportion of casein. 

In reaction cow's milk, though slightly alkaline or amphoteric 
when freshly drawn, soon becomes somewhat acid, while woman's 
milk is amphoteric or alkaline. 

As there is very little difference in total solids between the two, 
their specific gravity is about the same. 

The sugar of cow's milk and woman's milk is lactose in complete 
solution. They differ, however, in quantity, as woman's milk con- 
tains 6 to 7 per cent, while cow's milk has usually 4.5 per cent. The 
greater part of the* fat in cow's milk is neutral fat, as in woman's 
milk; but cow's milk contains far greater quantities of the volatile 
fatty acids, of which there are but traces in woman's milk. It is 
in the proteids that the chief difference between cow's milk and 
woman's milk is manifest. Cow's milk has on the average 3.50 per 
cent of proteid to 1.50 per cent in woman's milk. The reason for this 
difference is obvious. As all growth is dependent upon proteid ma- 
terial, and animals are unable to build up proteids within themselves 
from the nonnitrogenous portions of their diet, they are dependent 
for their supply upon the ingestion of proteid in their food. As the 
ratio of growth of the calf compared to the infant is about as 2 is to 1, 
it follows that the calf requires relatively twice as much proteid as 
does the infant. Moreover, owing to differences in their respective 
digestive tracts, the proteid in cow's milk is of a different composition 
from that of woman's milk. In the human being the stomach forms 
20 per cent of the intestinal tube and digestion is chiefly intestinal. 
In the cow the stomach forms 70 per cent of the digestive tract and 
digestion is chiefly gastric. Under the action of the active rennet 
ferment present in the stomach of the calf, cow's milk forms a large 
curd which remains in the calf's stomach until digestion is complete. 
In the infant the soft, flocculent curd of mother's milk is adapted 
to easy transit from the stomach to the duodenum, and it is alto- 
gether likely that a portion of the milk ingested does so pass out 
before the nursing is finished. 

In view of the foregoing, as casein is the curding proteid in milks, 
we should expect to find, as is actually the case, that the proteid of 
cow's milk is richer in casein than the proteid of human milk. Koenig 
gives the following composition of the proteids in cow's milk and 
human milk : 



717 





Lactal- 
bumen. 


Casein. 




Per cent. 

1.26 

.53 


Per cent. 
1.03 




3.02 







The proteid of cow's milk when coagulated by rennet in the test- 
tube gives a firm, tough, contractile curd. Heubner, however, has 
shown that we can by no means infer that this is the action in the 
human stomach ; for, if rennet is added to cow's milk in a test tube, 
the tube subsequently corked, and then slowly turned over end for 
end to imitate the movements of peristalsis, the resulting curd is 
every bit as fine as the curd of human milk. This statement Heubner 
confirmed by withdrawing cow's milk shortly after ingestion by 
infants with a stomach tube. 

This brings us to the consideration of a fact due to the researches 
of Heubner, Keller, and Czerny, which tends to revolutionize all 
our preconceived notions on this side of the Atlantic at least as to the 
digestibility of cow's milk proteid. For many years it has been held 
that the proteids of cow's milk are very difficult of digestion. To 
overcome this supposed difficulty very many devices have been advo- 
cated. Thus various alkalies and diluents have been applied, the 
percentage of proteids has by modification been attenuated almost to 
the vanishing point, split proteids have been advocated, a portion of 
the casein being replaced by whey proteid — in short, almost every 
conceivable device that ingenuity could suggest. 

This would be highly commendable were cow's milk proteid really 
so difficult of digestion by the human infant. The researches of the 
investigators just adverted to have shown this important fact, viz, 
that cow's milk proteid is almost as easily digestible per se by infants 
as are the proteids of woman's milk. In this country Brennemann 
and Walls a have confimed this view. On the other hand, Czerny 
and Keller have shown that the element in cow's milk which causes 
digestive disturbance is the fat and not the proteid. They have given 
us a very precise and definite clinical picture of these disturbances, 
a picture perfectly familiar to all who have dealt much with the 
artificial feeding of infants, but which has been ascribed heretofore 
in this country to difficult proteid digestion. 

Let us then examine the basis for this belief which has hitherto 
been regarded as a fundamental fact ever to be considered in the 
percentage system of the modification of cow's milk. It has been 
based for the most part on these facts: First, that in the stools fol- 

°Am. Journal Med. Ass., 1907, Vol. XLVIII, 1338-1344; Ibid., F. X. Walls, 
pp. 1389 to 1392. 



718 

lowing gastrointestinal disturbances in infants a large number of 
apparent curds are mingled with the fecal discharge. They look 
like curds and have been taken for curds without further investiga- 
tion. Czerny has shown that they consist for the most part of saponi- 
fied fat, neutral fat, and fatty acids, interspersed in severe cases with 
clumps of bacteria. 

If infants are fed on fat-free cow's milk, although the milk be 
undiluted and containing 3.50 per cent of bovine proteid, no trace 
of casein appears microscopically in the stools, yet Chapin tells us 
it is rare to find an infant 10 months of age who will digest more 
than 1.50 to 2 per cent of cow's milk proteid. 

In this country, the digestibility of cow's milk proteid has been 
confirmed by Walls a after a series of hundreds of observations. Now 
Czerny has shown that the persistent ingestion in a child of a diet 
with an energy quotient surpassing 100 calories per kilogram of body 
weight is invariably followed sooner or later by nutritional disturb- 
ances. Owing to the fact that infants receive for the most part 
nothing but milk, and that the percentage of sugar and proteid in 
rnilk is pretty nearly constant, it follows by reason of the high caloric 
value of the fat (9.3 calories) that a high energy, quotient implies 
an excess of fat. It is impossible, by mere inadvertence, with carbo- 
hydrate or proteid alone to get an energy quotient of a dangerous 
height without producing a food which either from its state of con- 
centration or by reason of its bulk would be obviously unfit to feed 
to any infant. On the other hand, slight increases of 1 or 2 per cent 
in the fat content of a food may have the effect of raising its caloric 
value to a dangerous extent. 

The action of an excess of fat in causing nutritional disturbances 
in infants operates in two ways; first, by reason of its action on the 
alkaline bases of the body, and second, by its influence on gastric 
digestion. 

Action of excess of fat on alkaline bases of body. — According to 
Czerny and Keller, the deleterious influence of an excess of fat in the 
diet is usually operative by reason of the abstraction such excess 
entails on the alkaline bases of the organism for the purposes of its 
saponification in the intestinal tract. It is evident that, owing to its 
high caloric efficiency and the greater difficulty of its oxidation as 
compared both with proteid and carbohydrate, the general capacity 
of the organism for the absorption of fat is strictly confined within 
narrow limits. Whereas an excess of proteids and carbohydrates is 
disposed of rather easily by the process of metabolism, with fats such 
is not the case. An excess of fatty food is not absorbed, but remains 
in the intestine and is there saponified. This is not due so much to 

o F. X. Walls, Am. Jour. Med. Sci., 1906, II. 



719 

efforts of the organism to get rid of the fat in this way as to the 
natural tendency of fat to undergo this action when exposed to the 
action of alkaline fluids such as the intestinal secretions. In this 
way an excessive abstraction of the alkaline bases of the body takes 
place, which are in turn supplied to the body, in milk at least, in 
quantities merely sufficient for a normal diet. The income, then, of 
these bases becomes less than the outgo, and a pathological condition 
due to this diminution is thereby induced. Owing to the greater 
energy required in its digestion, the tendency of cow's milk is to 
remain longer in the intestinal tract. This gives greater opportu- 
nity for any excess of fat present to rob the body of alkaline bases by 
virtue of its saponification. As a consequence of the general richness 
of cow's milk in this country, such danger of excess of fat must 
always be present when the milk used as an article of infant food 
is not controlled in this respect. It would seem that a milk which 
contains 4 per cent of butter fat were somewhat too rich and that a 
fat content of 3 to 3.5 per cent would be nearer the mark to insure 
success in infant feeding. The experience of dairymen tells us that 
calves do best on this ; moreover, the production of rich milk in cows 
is not attended by a corresponding increase in the salts present, as 
rich milk is a result of careful breeding for that purpose by man, and 
is not a condition original to the milk of the cow. 

The second effect excessive fat has in promoting gastro-intestinal 
disturbances lies in its behavior when casein is curded by rennet in the 
stomach. It is well known, among cheese makers at least, that casein, 
when coagulated by rennet, carries down with it a very large per 
cent of the butter fat present. This is well shown in the case of the 
cream cheeses, some of which contain nearly six times as much fat in 
their composition as casein. As the whey from whole milk contains 
no casein and less than 1 per cent of fat, it is obvious that the casein 
when curded brought down with it some 75 per cent or more, accord- 
ing to the richness of the milk, of all the butter fat originally present 
in the milk. The practical bearing this has upon the digestibility of 
cow's milk proteid is as follows: The richer the milk in fat, the 
greater percentage of fat will then be in the curd formed by the 
gastric digestion. 

A very simple experiment will show in what way the digestibility 
of a rich whole milk would thereby be affected. Place a small por- 
tion of skimmed milk in a small flask with a narrow neck. In an- 
other flask place a similar portion of a rich milk containing say 5 
or 5.25 per cent of fat. Add a small portion of liquid rennet to each, 
cork, and turn them slowly over and over in order to simulate peri- 
staltic action. In the case of the skimmed milk, as curding takes 
place, we see the formation of a flocculent curd, each particle of 
which remains separate. In the case of the milk rich in fat, the curds 



720 

are dense and heavy, and show a remarkable tendency to coalesce and 
stick together. This is well brought out by attempting to pour out 
the curded milk from each bottle. Now, the curded skimmed milk 
pours out very easily, and, on examination, the curds are distributed 
throughout the whey in light flocculent masses, while in the case of 
the milk rich in fat, pouring out will frequently be interrupted by 
large lumpy curds sticking in the narrow neck. Agitation of the bot- 
tle to break them up merely seems to increase their adhesive powers, 
each lump receiving further accretions from the particles floating in 
the neighborhood. 

We can easily, then, predict the events that take place when a milk 
rich in fat is acted upon by the gastric juices in the infant's stomach. 
In fact, this action of fat in making curds, large and indigestible by 
reason of their excessive fat content, has long been known to dairy- 
men, as they are well aware of the fact that Jersey cows often can not 
nurse their calves by reason of the excessive richness of their milk. 
And yet one would never for one moment suppose, under normal cir- 
cumstances, that the casein of cow's milk is ever indigestible per se to 
the calves for which it is intended. 

In the case of the human infant, if the milk be too rich it is vom- 
ited. If it is just rich enough to produce a curd with a fat content 
greater than it should have, peristalsis is checked and the stomach 
discharges its contents slowly. This retarded action in the dis- 
charging action of the stomach is to permit its gastric juices to act 
upon the casein in the fatty curds present. As a result, the next meal 
finds the stomach with a residue from the one previous, to which is 
added the increment just received. In this manner the gastric con- 
tents become progressively richer both in fat and proteids. As this 
highly seasoned mass is poured out little by little into the duodenum 
and small intestine, it, in its turn, becomes encumbered with a food 
the problem of whose digestibility is beyond its resources. Gastric 
as well as intestinal digestion is well-nigh at a standstill; fermenta- 
tive changes take place, and then, in the language of the German 
investigators, the so-called " ' catastrophe ' ensues." 

This, of course, is an extreme case. Czerny has graphically delin- 
eated the symptom complex observed when the feeding of foods is 
persisted in whose energy quotients surpass the normal limit of the 
organism, especially when such excess consists of fat. An infant that 
has been thriving receives some new addition to its food. This may 
either be an increase in the quantity or an addition to the richness 
of its ingredients. For a while a remarkable gain in weight is ob- 
served. The infant, however, soon becomes restless, its sleep is light 
and broken. It seems somewhat nervous and becomes less active and 
playful. At the same time its keen appetite diminishes and it has to 
be coaxed to drink its food. Often 2 or 3 ounces will be left in the 



721 

bottle or glass. The stools, hitherto of normal odor, color, and con- 
sistency, become pale-gray, hard, and dry. In fact, they are of the 
color and consistency of putty, and may be rolled off the diaper with- 
out even soiling it. Their odor is strong and suggests decomposition. 
The urine becomes charged with ammonia salts and stains the diapers. 
Systemic effects are shown by the pallor of the child ; the tissues lose 
their firmness and solidity, becoming flabby and relaxed; the child 
also fails to gain in weight on the same food or a greater quantity of 
the same food which has hitherto produced a gain in weight. A 
persistence in this course of feeding not only does not increase the 
weight, but occasions a loss. Two results follow the continued exhi- 
bition of such a diet. The body tissues waste, the belly distends with 
gas, and we have the atrophic or marantic child, or a gastro- intestinal 
catastrophe results with vomiting, diarrhea, fever, and prostration, 
accompanied by an inability to take cow's milk for a period often 
extending into weeks. Such, then, are the symptoms in the more ag- 
gravated cases. In those more chronic the anorexia and constipation 
go hand in hand, the former and the latter being almost constant. 
Outbreaks of eczema are common, from small roughened patches on 
the cheeks to eruptions invading large areas. As the child grows 
older the symptoms of rachitis are observed. 

The firm, pale-gray stools so characteristic of this condition are 
composed largely of fatty soaps (Seifenstuhlen). Czerny and Keller 
ascribe the pathology of this condition to the action of fat in extract- 
ing the alkaline bases already alluded to, as shown by the increased 
elimination of ammonia in the urine. They regard this elimination 
of ammonia salts due to the fact that the alkaline bases are so largely 
drawn upon from the body to saponify the excessive amount of fat 
accumulated above the needs of the organism in the intestine, that in 
order to satisfy the normal acid products of metabolism the ammonia 
salts are drawn upon. 

Percentage system of artificial feeding. — In this manner we see di- 
vergent points in this view of the whole question of infant feeding 
as compared to that in vogue on this side of the Atlantic. The per- 
centage system of modification of milk rests upon the following 
premises, two of which are certainly faulty : 

First. That a substitute for mother's milk must resemble it in the 
relation and chemical composition of its ingredients ; 

Second. That this condition is fulfilled only by some milk ; 

Third. That cow's milk is the only practical substitute; 

Fourth. That the chief difficulty in the use of cow's milk is the in- 
digestibility of its proteid by infants ; and, consequently, 

Fifth. The composition of cow's milk must be so altered by appro- 
priate manipulation as to provide those relative proportions of pro- 
45276°— Bull. 56—12 m 



722 

teid, fat, and milk-sugar which experience teaches us is suitable for 
the different ages of the child. 

We will now proceed to discuss wherein these principles are erro- 
neous. The error seems to be embodied in principle 4 and princi- 
ple 5. 

The fourth principle, i. e., that the casein of cow's milk is indiges- 
tible, has been shown to rest upon a misconception. It only helps 
in a mechanical manner to produce indigestion when combined with 
large quantities of fat, or is altered in its digestive quality by fermen- 
tative changes in the milk at the time of consumption. 

It is the taking of the assumption of the indigestibility of the 
casein of cow's milk for granted that has caused the rather numerous 
instances of overfeeding in the case of American children. In fact, 
under our present system overfeeding is apt to be the rule rather than 
the exception. By reason of the belief that the proteid of cow's milk 
is the essential indigestible portion of its ingredients, it has been 
reduced, in the milk modifications prescribed by many of our physi- 
cians, almost to the point of extinction in certain individual cases. 

Eealizing, however, that food offered to a child must contain cer- 
tain elements of energy, the place of the proteid has been supplied 
by the use of fat, which, until in recent years, has been regarded 
digestible by many of our pediatrists and to act in conjunction with 
the carbo-hydrates as a proteid saver, besides promoting free action of 
the bowels. 

And yet what better proof that fat is the cause of constipation could 
be adduced than by the following circumstance which Walls a has 
observed in so many instances, viz, that whenever the symptoms of 
fat intoxication are manifest, as evinced by the characteristic stools, 
a diet of fat- free whole milk works like a specific in initiating normal 
intestinal action. 

The fifth principle, going hand in hand with the fourth, is likewise 
erroneous in basing the composition of the milk modifications offered 
on the age alone of the child who receives them in so far as the 
weight of the child and the amount of the heat units necessary to 
nourish it and give it growth are not taken into proper consideration 
thereby. Moreover, only lately has the principle been recognized that 
food elements, if furnished even in trifling excess, instead of inuring 
to the benefit of the infant, have a way of reacting to his detriment. 
The following table, taken from a well-known text-book on pedi- 
atrics, can be used to further illustrate these points : 

«Loc. cit. 



723 



Approximate schedule for milk modifications for various ages. 



Age. 


Fat. 


Sugar. 


Proteid. 


Quantity at one 
feeding. 


Number 
of feed- 




Ounces. 


Grams. 


24 hours. 




1.00 
1.00 
1.50 
2.00 
2.50 
3.00 
3.00 
3.50 
3.50 
4.00 
4.00 
4.00 
4.00 


4.00 
5.00 
5.00 
6.00 
6.00 
6.00 
6.00 
7.00 
7.00 
7.00 
5.00 
5.00 
4.00 


0.25 

.30 

.50 

.60 

.80 

1.00 

1.25 

1.50 

1.75 

2.00 

3.00 

3.00 

3.50 


1-1* 

1-2 
2 - 2£ 
2-3* 
2|-4 

3-5 

4-6 
5-8 
7-9 
7-9 
7 -10 


7- 22 
30- 45 
30- 60 
60- 75 
60-110 
75-125 
90-155 
110-170 
125-185 
155-250 
220-280 
220-280 
220-310 


12-18 




6-10 




10 




10 




10 




9 




8 




7 


Fifth month 


7 




6 


Eleventh month 


5 


Twelfth month 


5 


Thirteenth month 


5 







If, for example, we take from this table the formula advised for 
the second week — i. e., fat 2.00, sugar 6.00, proteids 0.60 per cent — we 
find such a ration furnishes a caloric value of 0.457 calories per gram. 
The total amount administered is 600 to 750 cubic centimeters a day, 
giving a caloric value of 274.2 to 342.75 calories per diem. Assuming 
that a healthy average child weighs 3,500 grams at the beginning of 
the second week, the energy quotient required is 100 calories per kilo- 
gram of body weight. It will then require food supplying 350 calories 
a day properly to nourish it. 

We see, however, that not only the lowest but the highest ration 
furnished by this table is less than its actual requirements. The 
ration is also very poor in proteid in contradistinction to mother's 
milk, which is normally higher in proteids during the first weeks than 
at other periods of lactation. Of course, the theory for this modifi- 
cation is that higher proteid would upset the digestion. This objec- 
tion can be no longer regarded as valid. This is not, however, a very 
serious disadvantage of this table. Under-feeding never caused seri- 
ous gastro-enteritis, and as a consequence babies fed on this plan 
usually pass without digestive disturbance through the initial for- 
mulae, though they gain weight but slowly from them. 

It is when we turn to the percentages advised for older infants 
that the possibilities of danger are apparent. Taking the daily ration 
advocated for the infant of 6 months, we find that the percentages of 
this ration are as follows : Fat 4.00, sugar 7.00, proteid 2.00 per cent. 
This gives a caloric value of 741 calories per kilogram, or 0.741 calo- 
ries per gram. The daily quantity recommended varies from 930 to 
1,500 grams, giving a total daily caloric value of 689.1 to 1,011.5 calo- 
ries. Supposing a 6-months-old infant to have attained the weight of 



724 

7,300 grams (16 pounds), and requiring an energy quotient of 90, we 
see that the energy quotient furnished by the above diet varies from 
92, or near the safety limit, to the dangerous figure of 134.8. 

Now, as long as everything is going well, and we have no scien- 
tific guide on which to base our calculations, the tendency is to give 
an artificially fed infant as much food as it will absorb within the 
indicated limits of the schedule. 

As the higher limit of 1,500 grams a day was being approached, 
a gratifying and remarkable increase in the gain in weight would 
be observed. This, as Czerny tells us, is a significant sign that the 
income and the outgo are not correctly balanced and calls for imme- 
diate reduction in the energy quotient of the food. 

That this position is sound a little reflection will make clear, as it 
is evident that growth, being the result of anabolic effort on the part 
of certain organs, must necessarily have a certain maximum rate of 
increment beyond which we pass into the pathologic. In our hypo- 
thetical instance, satisfaction at the child's remarkable and unex- 
pected gain in weight would further the inclination to continue with 
greater quantities of the food that has agreed so well with it. In this 
manner the physiological needs of the child having been long sur- 
passed, the symptoms of over- feeding as previously described become 
evident, either the gastro-intestinal catastrophe or the anorexia, 
constipation, and continual recession in weight. 

In the case of the first outcome, withholding of the milk and ap- 
propriate treatment is instituted, with the result, however, that much 
valuable ground is lost, and we have a child who perhaps for weeks 
can not take any form of cow's milk at all. 

In the second, the results may vary. The digestive disturbances 
are, as a usual thing, erroneously attributed to the cow's milk pro- 
teids. The constipation may be regarded as the result of a lack of 
fat, which may be added to a diet already overcharged with this, and 
a gastro-intestinal crisis definitely precipitated. 

We must, therefore, regard the percentage system of feeding as 
based upon conclusions that are incomplete and the result of clin- 
ical observation alone, a form of observation that is prone to lead to 
inferences incorrectly grounded in fact. Without deprecating the 
skill and care used in working out these formulas there is occasion 
for regret that until very lately, in the belief of the complete scien- 
tific accuracy of our methods, we have failed to undertake any obser- 
vations for ourselves as to the nutritive requirements of infants, and 
the actual digestive absorption that takes place in respect to the vari- 
ous constituents of human and other milks in the infantile digestive 
tube. We see by the foregoing that the whole question of the arti- 
ficial feeding of infants may be reduced from a condition of extreme 
complexity, based upon the incomplete data of clinical observations, 



725 

to a relatively simple and scientific basis. The principles, briefly 
stated, consist in feeding to every child who must be artificially fed 
a food which, based on the age and weight of the child, will furnish 
it with the energy quotient it requires and no more, and to continue 
the food at that composition and quantity until a diminution in 
the weekly gain of weight, unaccompanied by symptoms referable to 
the gastro-intestinal tract, informs us that an increase in the diet 
is necessary. 

As we need no longer be deterred by our fears of the indigestibility 
of cow's milk proteid, in the absence of excessive quantities of fat, 
or changes due to fermentation, undiluted cow's milk can be given 
from the beginning of the first month on, provided its content of fat 
does not exceed 2 to 3 per cent, nor the daily quantity greater than 
150 cubic centimeters per kilogram of body weight. 

To settle any doubt as to the digestibility of whole cow's milk in 
the stomach of infants, we have but to turn to the observations of 
Budin, Oppenheimer, Variot, Comby, Lazard, Drapier, Ruffle, Bon- 
ifas, Gillet, and others, men of large experience, who have fed infants 
from the earliest days in life on whole cow's milk in proportion to 
their needs without observing anything but the happiest results.® 

In feeding cow's milk undiluted to infants in this country our prac- 
tice in this direction must be controlled by the following circum- 
stance : Abroad, owing to different methods in feeding, and different 
grades of cattle, milk containing over 3.75 per cent of butter fat is 
rarely found, and the average is probably not over 3 to 3.50 per cent 
in the majority of cases. In our country it is a milk poor in butter 
fat indeed which does not average 4 per cent, while selected milk sup- 
plied to many of our institutions and hospitals and our " certified " 
grades of milk are often nearer 4.50 or 4.75 per cent. Thus Chapin 
found that the average content of fat of the milk used in the Babies' 
Ward of the Postgraduate Hospital in New York was 4.40 per cent. 
The use of milk of this grade of richness is likely to be followed by 
digestive disturbances and symptoms of overfeeding when fe^ whole 
to infants, both by reason of excessive caloric value and of the forma- 
tion of large fat-containing curds. 

While agreeing with the experience in France of the digestibility 
of undiluted cow's milk as an infant food, I am not prepared to ad- 
vocate its use in this country unless the fat content is known to be 
no higher than 3.00 per cent. This condition can, however, be secured 
either by using milk from Holstein cattle, which is normally no richer 

° Budin : The Nursling. Comby : Medicine Moderne, Mar. 14, 1894. Lazard : 
Journal de Cliniques et de Therapeutiques Infantiles, L895,886. Darpier : Rap- 
port sur le fonctionnence de la creche. Ruffie : La Gouttette on la diarrhee 
verte des nourissons et son traitement par le lait sterilise. Bonifas : Le Progrds 
Medicale. Gillet : Formulaire d'Hygiene Infantile Individuelle. 



726 

than this, or by removing appropriate amounts of the " top milk " 
from bottled milk after the cream has risen and then thoroughly mix- 
ing the remainder. 

GENERAL DIRECTIONS FOR THE ARTIFICIAL FEEDING OF INFANTS. 

For children one month old or over. — First, weigh the child. 
Allow a daily quantity of cow's milk of one-seventh body weight 
for infants up to 3 months of age, one-eighth the body weight from 
3 months to 6 months, and after that from one-ninth to one-tenth. 

Quality of milk to he used. — Use nothing but clean, fresh, bottled 
milk, " certified " if possible. If this can not be had, use bottled 
milk from a high-grade dairy, making sure that the fat content 
does not exceed 3.00 per cent. If it is greater than this it must be 
reduced to this figure by dipping the cream out of the top of the 
bottle in the amounts given in the following table and then mixing 
thoroughly the remainder. 

Note. — A cow's milk of this percentage of fat — 3.50 — has a heat value of 
653.5 calories per kilogram, or about the average caloric value of woman's 
milk. 



Table showing quantities of top milk that must be removed, from top of quart 
bottles of milk in order to reduce the percentage of fat to 3.00 per cent. 



Original percentage of fat in the milk. 


Quantity of cream to be removed from top 
of quart after cream has risen to reduce 
fat to 3.00 per cent. 


4. 00 




4.50 




5.00 









Mix the milk thoroughly by pouring into another vessel and 
measure out the amount of the daily supply requisite as indicated 
by the age and weight of the child ; e. g. : Weight of child 1 month 
old, 4 kilograms (9 lbs.) ; \ of body weight=570 grams (19 ounces) ; 
daily quantity of milk=570 grams (19 ounces). Divide the quantity 
of milk so obtained in nursing bottles each containing equal amounts 
according to the daily number of feedings advocated in another 
part of this paper (see breast feeding). Sterilize it by standing the 
bottles, each corked with absorbent cotton, in boiling water up to 
their necks and boil for a period of three-fourths to one hour. Cool 
and preserve the bottles on ice until required. Before feeding heat 
the milk to blood temperature by standing the bottle in hot water. 
Sterilization of the milk is advocated in the case of all infants under 
3 months of age for reasons presently to be discussed. After that 
time it may be discontinued, and pasteurization of the milk substi- 
tuted until the eighth or ninth month, when raw milk may be used, 



727 

provided the weather be cool, the milk reliable, and the use of the raw 
milk produces no digestive disturbance. During the summer it is 
better to pasteurize or to sterilize all milk used in infant feeding. All 
pasteurization and sterilization are, however, processes to be reserved 
for home use only. As a rule milk that has been commercially pas- 
teurized or sterilized should not be used, as it may have been imper- 
fectly kept by the dealer after the process. 

Reasons for the sterilization and pasteurization of milk, — Apart 
from the safety the sterilization or the pasteurization of milk con- 
fers by virtue of the destruction of all its nonspore bearing bacteria 
(the word " sterilization " is not used here in the laboratory sense, 
but refers merely to measures which will destroy ordinary patho- 
genic organisms) there is abundant and incontrovertible evidence 
to show that by these measures both the morbidity and the mor- 
tality of infants from gastro-intestinal disease has been greatly 
reduced. 

There are also additional and important reasons in the case of 
infants of less than 3 months of age which render the steriliza- 
tion of the milk from their use especially desirable. Russell has 
shown that heating the milk destroys the tendency of the fat globules 
to coalesce and distributes them uniformly throughout the milk. 
This combined with the partial inhibition of the curding action of 
the gastric juices upon the casein of heated milk prevents the for- 
mation of large fat containing curds in the stomach. 

Now, the gastric capacity of young infants is both absolutely and 
relatively very small. During the act of nursing, when the stomach 
has been filled a portion of its contents is passed on into the duode- 
num. That this must take place is readily shown by consulting the 
records of Feer's investigations and by comparing the amounts taken 
at single nursings with the absolute gastric capacity of infants of 
that age as determined by Pfaundler. 

The soft, flocculent, diffluent curd of heated milk readily permits 
this action to occur as the stomach reaches the point of physiological 
distension. 

Objections to the use of sterilized milk. — The use of sterilized milk 
for the feeding of infants has often been objected to, first, on account 
of supposedly greater difficulty in digestion, and second, because of 
the danger of producing infantile scurvy thereby. The first objection 
is founded upon misapprehension, as can readily be shown by com- 
paring the action of rennet ferment on raw milk and on milk that 
has been previously heated. The raw milk coagulates firmly, while 
the heated milk has a soft, almost diffluent clot. Moreover, careful 
investigations of the digestive absorption of the constituents of heated 
milk have shown evidence of a considerably greater degree of com- 
pleteness in such absoption than is the case in unheated milk. This, 



728 

conjoined with the favorable experience of the French clinicians with 
heated milk, must be regarded as conclusive evidence of the supe- 
riority of both sterilized and pasteurized cow's milk present over raw 
cow's milk in this respect. The second objection, that of causing 
infantile scurvy, I believe, can be demonstrated to reside, in all prob- 
ability, in qualities inherent in the milk used and not attributable to 
the mere fact of its sterilization. Scurvy has been seen not only as 
the result of pasteurized or sterilized milk, but also in breast-fed chil- 
dren and in those fed on raw cow's milk. We may, therefore, infer 
that certain constituents necessary to the nutrition of the body were 
not being supplied. At Professor Budin's clinic in Paris, at all the 
numerous milk depots ("Gouttes de Lait") scattered throughout 
France, where nothing but unsophisticated, sterilized cow's milk is 
used for the artificial feeding of infants from the earliest age, infan- 
tile scurvy is practically unknown. Budin tells us of a visiting physi- 
cian who was unable to convince himself that sterilized milk did not 
produce scurvy. Budin invited him to inspect the infants who pre- 
sented themselves with their mothers for their weekly inspections and 
weighings, as they are obliged to do. Every babe was stripped and 
the visitory was able to verify for himself that not one presented signs 
of scurvy or even of rickets in the slightest degree. 

I would put forth tentatively the following development of Ralfe's 
theory as to the causation of scurvy as a possible explanation in this 
connection of the etiology of infantile scurvy and tending to remove 
this odium from whole, sterilized cow's milk, not too rich in fat. On 
theoretical grounds, scurvy may be regarded as a pathological condi- 
tion caused by the diminution in the body of those alkaline bases 
which are necessary for the maintenance of a normal condition of 
health. These are ordinarily supplied in our food in the form of 
salts of the alkaline bases, especially potassium. Now, I would go a 
step farther and say that in order to undergo absorption during 
digestion, these salts must be supplied in combination with an acid 
radical which can be set free by the action of the digestive juices, such 
as phosphoric, citric, malic, and similar acid radicals. The negative 
proof of this contention is the rapidity with which scurvy is cured 
when the system is freely supplied with such salts. 

I think two causes often going hand in hand are mainly responsible 
for the production of scurvy in infants. The first is an absolute in- 
sufficiency of the salts alluded to and the second is a relative insuffi- 
ciency of these salts when compared with the fat present in the diet. 

In regard to the latter condition we have seen how a diet excessive 
in fat may draw upon the alkaline bases of the body for the purposes 
of saponification. When they are being inadequately supplied in the 
food as well it is easy to see that the time would not be long in coming 
when the available supply would be depleted, radical changes 



- 729 

wrought in the composition of the body tissues and the constitu- 
tional symptoms would follow. 

In many of the cases of infantile scurvy caused by sterilized milk 
the formulae used seems to have been the causative factor, i. e., low 
proteids or low proteids and high fat. Now all .such modifications 
are derived from the dilution of top milks and creams with water. 
This implies that the quantity of the mineral salts present in the 
milk is greatly diminished, as, in order to produce this relative pro- 
portion of fat and proteid, small amounts of these top milks and 
creams are diluted with large volumes of water. 

Thus a modified milk mixture of the following formula: Fat, 3; 
sugar, 6, and proteid, 1, is obtained by diluting 6 ounces of 10 per 
cent cream with 12 ounces of water and adding 1 ounce of milk sugar. 
This has at once the effect of reducing the mineral salts in this mix- 
ture to one-third the amount present in a similar amount of whole 
milk. When higher fat modifications derived from cow's milk are 
used without increasing the proteid, or when the proteid percentage 
is to be reduced, a richer cream must be taken in smaller amount and 
diluted with a greater volume of water. On the other hand, I would 
attribute the occurrence of cases of scurvy which have been observed 
to result from the use of whole sterilized cow's milk to the presence 
of an excessive amount of fat in the milk, which, by reason of the 
greater digestibility of sterilized milk, when compared to raw milk, 
was ingested without causing acute gastro-intestinal disturbance. 

It is easy to see, then, how a milk modification in which the min- 
eral salts are greatly reduced, or even a rich whole milk, which by 
virtue of its sterilization is thereby made easier of digestion, may, on 
the one hand either by deficient supplying of alkaline bases, and on 
the other by their excessive abstraction from the body for the pur- 
poses of saponification, produce in the long run the alteration of the 
body tissues and fluids which may result in scurvy. It may, how- 
ever, be objected that the proprietary foods and condensed milk, 
which are anything but rich in fat, are themselves the most prolific 
causes of infantile scurvy. 

This objection may be met by the fact that these are concentrated 
foods, and, for use, are diluted with large volumes of water. In the 
case of condensed milk, at least, this has the effect of reducing the 
salts far below the limit required by the body. Thus, condensed 
milk, when diluted with 6 parts of water, contains 0.17 per cent, with 
12 parts 0.10 per cent, and with 18 parts 0.07 per cent of these salts. 
These are the dilutions ordinarily used in the feeding of infants. 
Taking woman's milk as a standard of infant needs in this respect 
in maternal nursing, at least, we find, according to Von Bunge, that 
potassium and sodium are by far the preponderating alkaline bases 



730 

in its salts, and that the child requires of them 0.07 and 0.025 per 
cent, respectively, in its food. 

This, however, may be said to be true only when lactation is well 
established. During the first weeks of lactation the percentage of 
mineral salts present is higher than this, which may have the effect 
of increasing the reserve supply. As these salts are present in whole 
cow's milk in the proportions of 0.17 and 0.05 per cent, it will be 
seen that the dilution of condensed milk as given above reduces them 
to infinitesimal amounts, in the case of the first dilution 0.00309 and 
0.00085 of each. Nor does it necessarily follow that an amount of 
these salts similar to that furnished with human milk will be adequate 
when supplied in conjunction with other foods, as much depends upon 
the conditions governing absorption in the alimentary tract. In the 
case of the proprietary foods, scurvy has been met with in those cases 
where they have been used as a complete substitute for milk. In some 
of these foods, such as Nestle's, Eskay's, Ridge's food, and Imperial 
Granum, the amount of inorganic salts present, differing but little 
or being much less than those in condensed milk when diluted to the 
extent required for use, predicates a similar condition on their part. 
When we come to consider artificial foods in general I think we are 
justified in assuming that they should contain an amount of inorganic 
salts at least equal to that of the food, i. e., cow's milk, which has 
been the most successful in the artificial feeding of infants. When 
we reduce cow's milk to the basis of the relative proportion of its 
solid constituents to each other we find that cow's milk has the fol- 
lowing average composition: 

Per cent. 

Fat 31. .25 

Sugar 35.16 

Proteid 27.34 

Salts 6.25 

100. 00 

There seems to be no proprietary food on the market that ap- 
proaches cow's milk in the respect of its content of inorganic salts in 
proportion to its other ingredients, the nearest being in the case of a 
food (Garnrick's) which contains 4.42 per cent of inorganic salts, and 
of which considerably over one-half of its content of carbohydrate is 
insoluble, a condition which must certainly be taken into account 
when considering the availability of such salts for absorption. 

We may, therefore, with reason, I think, dismiss our fears of the 
production of infantile scurvy by the use of sterilized or of pasteur- 
ized cow's milk, administered in suitable quantities, provided its in- 
organic salts are not reduced too greatly by dilution nor its fat con- 
tent excessive (over 3 per cent). If these conditions are complied 
with, I am convinced that the dangers of scurvy from its use have 



731 

been greatly overestimated. At all events, the danger involved from 
the use of sterilized or of pasteurized milk with respect to scurvy is 
so small, under these conditions, in comparison with the advantages 
to be derived that they may be disregarded. As an additional 
prophylactic when desired, however, we may avert all danger by the 
administration once or twice a day of a small quantity of orange 
juice (say 15 to 30 cubic centimeters) one hour or so before feeding. 
It is needless to say that the juice so administered must be from per- 
fectly fresh fruit and strained free from particles of skin. 

PASTEURIZATION OF MILK. 

This consists in the heating of milk to 60° C. (140° F.) for twenty 
minutes. While insufficient for the complete sterilization of milk, 
it destroys most of the nonspore-forming micro-organisms, including 
the pathogenic germs, besides not altering materially the taste of the 
milk. It is therefore recommended for milk to be used in feeding 
infants from the third month on, at least during the summer months. 

METHOD OF PASTEURIZING MILK. 

Water is brought to a boiling point in some utensil with a close- 
fitting lid. The utensil is then removed from the stove and placed 
on some nonconductor of heat, as a square of asbestos or a board. 
The feeding bottles are stood up to the level of the milk in them in 
the water, the utensil covered, and the whole left for twenty minutes. 
The milk bottles are then rapidly cooled by the use of cold water on 
the exterior of the bottles and are kept on ice until required. 

It is highly important to remember that neither sterilization nor 
pasteurization will make bad or stale milk good, and that once steril- 
ized or pasteurized it requires the same care in preservation as raw 
milk. Very convenient forms of apparatus, such as Arnold's or 
Soxhlet's, for sterilization, or Freeman's for pasteurization of milk 
can be bought at the shops. 

ARTIFICIAL FEEDING OF INFANTS UNDER ONE MONTH OF AGE. 

When we consider the composition of woman's milk in the early 
period of lactation, we are impressed with the fact that while the 
proteids are high, the sugar and fat are lower than at subsequent 
times. This has the effect of reducing its caloric value, and is doubt- 
less dependent upon the needs of the infant in this respect. 

We can, therefore, more easily imitate the provisions of nature by 
feeding skimmed milk to infants in the first month of life. Walls 
has found ° that sterilized undiluted skimmed milk is entirely di- 
gestible even by premature infants. As the energy quotient required 

° F. X. Walls, Jour. Am. Med. Assn., 1907, Vol. XLVIII, pp. 1389-1392. 



732 

by infants does not become high until the second week, it may be as- 
sumed that skimmed milk will more nearly meet their requirements 
at this age than whole cow's milk. 

Skimmed milk is obtained either as centrifugally skimmed milk 
from the dairy or by siphoning off the under half of a quart bottle of 
milk whose cream has risen. 

Skimmed milk has the following average composition : 

Per cent. 

Fat 0. 50 to 1. 00 

Proteid 3. 50 

Sugar 4. 50 

Salts 0. 75 

Water 90. 75 to 90. 25 

Caloric value per kilogram, 374.5 to 421. 

The amounts to be taken are determined as previously explained. 
After the end of the first week one-third whole milk and two-thirds 
skimmed milk can be given; after the end of the second, one-half 
whole milk and one-half skimmed milk ; at the end of the third week, 
three-quarters whole milk and one-quarter skimmed milk, passing to 
whole milk at the beginning of the first month. 

FEEDING OF OLDER INFANTS. 

The seventh month of infancy marks the time when it is desirable 
to supplement exclusive milk feeding by some other food. This 
should take the form of some cereal broth, and should be added to the 
milk in the proportion of one-third broth to two-thirds milk. 

The preparations recommended for this purpose are dextrinized 
gruels, oatmeal jelly, and barley water. 

Dextrinized gruel. — Make a thin paste of cold water and 1 or 2 
heaping tablespoonfuls of barley, wheat or rice flour, add 1 quart 
of boiling water, and boil for fifteen minutes in a double boiler. 
When the gruel is cool enough to be easily tasted, dextrinize by adding 
1 teaspoonful of diastase solution. An active solution of diastase 
may be prepared by soaking a tablespoonf ul of crushed malted barley 
grains in sufficient cold water to cover them (about 2 tablespoon- 
fuls) and placing the mixture in the refrigerator over night. In the 
morning the liquid which resembles weak tea is strained off. A table- 
spoonful of this fluid will dextrinize a pint of gruel in fifteen minutes. 
Or, a good commercial preparation of diastase may be used. 

Oatmeal jelly. — To 2 tablespoonfuls of oatmeal add 1 quart of 
water and boil for three hours, keeping up the quantity to 1 quart by 
the addition of water as it boils away. Strain through coarse muslin. 
As this forms a jelly when cold, it should be added warm to the food. 

Barley water. — This is prepared in the same way. Barley grains 
or barley flour may be used. If the former, soak the grains in water 
over night. 



733 

METHOD OF INCREASING THE INFANT'S DIET. 

As long as an infant is making satisfactory gains no change in the 
daily quantity of food is required. To this end, all artificially fed 
infants should be carefully weighed each week and the weights noted 
for future reference. "When the rate of gain for a week has suffered 
diminution, in the absence of other symptoms to account for it, we are 
to know that the time has come for an increase in the diet. The 
amount of this increase is determined along lines previously laid 
down, i. e.. by weighing the infant and giving it that proportion of 
food to its body weight indicated by its age. 

"We should be watchful for symptoms of overfeeding with every in- 
crease instituted in the quantity of the daily food. As long as the 
stools are normal in number, color, quantity, and consistency, and the 
urine remains limpid, no fear of overfeeding may be entertained. 

Wlien, however, loss of appetite is manifest, the bowels are con- 
stipated, pale, formed, and dry, the infant is being overfed, and a 
reversion to the former amount of its diet, or the substitution of 
skimmed milk for a few days must be employed until these symptoms 
disappear. 

PRECAUTIONS TO BE OBSERVED IN THE ARTIFICIAL FEEDING OF INFANTS. 

Every utensil used in the preparation of infant food should be 
clean. This does not mean a mere macroscopical cleanliness, but sur- 
gical cleanliness as well. Vessels used to hold the infant's food dur- 
ing its preparation should be scalded with boiling water after pre- 
vious thorough cleansing. Feeding bottles are to be cleaned after use, 
first with cold water, and then with warm water and some alkaline 
soap powder. Adhering particles of milk are to be removed with a 
bottle brush. The bottles are to be sterilized by boiling them in 
water, and storing them in an inverted position, when empty, to pre- 
vent the access of dust to their interior. "When new nursing bottles 
are bought, in order to prevent them from cracking from the ex- 
tremes of cold and heat to which they are subject, they should be 
annealed. This is accomplished by placing them in cold water, bring- 
ing the water to a boil, and allowing the bottles to remain in the water 
until it is cold. 

Only rubber nipples fitting on the necks of the bottles should be 
used. One should be able to turn them inside out for cleansing pur- 
poses. The hole in the top should be just large enough to allow the 
milk to drop rather rapidly when the bottle is inverted. If it issues 
in a stream the hole is too large. Xipples before use should be boiled, 
and may be kept in a saturated solution of boric acid. In feeding the 
child care should be taken to hold it in such a position that it can 
easily take its food. A child should not be coaxed to take more food 



734 

than it desires at the time, and its wishes in this matter should be 
treated with respect. Any portion of food left after a feeding should 
be thrown away, and on no account should it be used again. 

While, as a rule, it may be postulated that no infant is born with 
a digestion congenitally weak, still, as the result of inadequate feed- 
ing, both maternal and artificial, we do encounter infants whose 
digestive processes are a law unto themselves. The efficient nutri- 
tion of such infants often presents a problem which must be attacked 
upon individual lines. The investigations of Teixeira de Mattos, 
Salge, & and others have shown that fat-free buttermilk, or equal parts 
of buttermilk and malted cereal broths, are in many instances di- 
gestible with apparent satisfaction by such infants. As skimmed 
milk, also, is closely related to buttermilk in its composition, its use 
as an article of diet (sterilized) under these circumstances is warmly 
recommended. As soon as tolerance for cow's milk in this form is 
established, it must, however, be supplanted by a gradual return to 
whole cow's milk, as both buttermilk and skimmed milk are too poor 
in nutritve elements to furnish the basis for any long-continued 
scheme of artificial feeding. 

It should not be forgotten that atrophic infants require a greater 
energy quotient than the normal child of the same weight. This is 
due to two reasons, first, by reason of the greater radiation of heat 
on account of their deficiency in bodily fat, and second, because their 
proportion of living body cells is greater in respect to their weight 
than is the case in infants of normal nutrition. In the latter, 8 to 
12 per cent of their weight consists of fat, whose function in the 
metabolic processes, of the organism consists only in furnishing a 
storehouse for energy and in conserving the bodily heat. In the 
emaciated child of the same weight, the body consists almost entirely 
of cells performing vital functions, all of which require nutriment 
for their proper performance. In view of these facts, in such cases 
the food given may be increased above the normal both in quantity 
and in caloric value, taking care, however, not to provide such an 
excess that the digestion is thereby embarrassed, and to reduce the 
nourishment to amounts appropriate to the weight and age of the 
child as the normal average of weight for age is approached. 

It is also important to remember that cow's milk when compared 
with human milk is essentially an alien food. Both its fats and its 
proteids are different in composition from those of human milk and, 
being adapted to the nourishment of an animal on a different zoolog- 
ical plane, must of necessity be regarded as substances foreign to the 

° Teixeira de Mattos. Die Buttermilch als Sauglingsnahrung, Jahrbuch f. 
Kinderheilk., 1902, pp. 1-61. 

6 B. Salge. Buttermilch as Sauglinsnahrung, Jahrb. f. Kinderheilkunde, 
1902, 157-164. 



735 

human infantile digestive tract. As a consequence, greater energy 
is required for its digestion and assimilation, and it is of the highest 
importance that the infant metabolism be not further strained in this 
connection by the imposition upon it, in addition to this task, of the 
conversion of a milk whose digestibility is further impaired by fer- 
mentative changes due to its improper preparation and preservation 
as a food. 

While we can never hope to vie with natural nursing, an application 
of the principles briefly expounded in this paper will go far, I am 
convinced, toward eliminating the excessive complexity and uncer- 
tainty which have hitherto characterized the whole subject of infant 
feeding, and, in the main, be productive of better results than we can 
obtain by other methods. 



24. THE RELATIVE PROPORTION OF BACTERIA IN TOP 

MILK (CREAM LAYER) AND BOTTOM MILK 

(SKIM MILK), AND ITS BEARING 

ON INFANT FEEDING. 



45276°— Bull. 56—12 47 (737) 



THE RELATIVE PROPORTION OF BACTERIA IN TOP MILK 
(CREAM LAYER) AND BOTTOM MILK (SKIM MILK), AND 
ITS BEARING ON INFANT FEEDINGS 



By John F. Anderson, 

Passed Assistant Burgeon and Assistant Director Hygienic Laboratory, Public 

Health and Marine-Hospital Service, Washington, D. C. 



In the course of a study of tubercle bacilli in market milk b and 
of a later study of the best procedure for their detection in milk it 
was noticed that when guinea pigs were inoculated with the cream a 
very much higher percentage died from acute infections than when 
the sediment was used. The inference was natural that the cream 
contained more bacteria than the bottom milk or sediment. A few 
preliminary examinations having shown this supposition to be 
correct, a study was begun as to the number of bacteria in the whole 
milk, the bottom milk or sediment, and the cream, both that collected 
by gravity and by centrifugation. 

The relative number of bacteria in the top milk and in the bottom 
milk is a subject of very great importance in the modification of milk 
for infant feeding. All the writers on pediatrics and infant feeding 
give formulae for the modification of milk based upon the use of 
various amounts of top milk. My studies show that top milk, such 
as is advised for use in the above formula?, contains from 10 to 500 
times as many bacteria per cubic centimeter as the mixed milk. This 
preponderance of bacteria in top milk may account for the fact that 
sometimes children do not thrive on modified milk when made from 
top milk, but improve when the whole milk is used for modification. 

The various bacteria causing acute infections, as well as tubercle 
bacilli, are more numerous in the top milk than in the bottom milk. 
In many cases this difference is more than a hundredfold and, as 
infection must depend to some extent on the number of bacteria intro- 

d This is a summary of a paper read before the American Public Health 
Association in Winnipeg, Canada, August 31, 1908. 

6 Anderson, John F. : " The frequency of tubercle bacilli in the market milk 
of the city of Washington, D. C." Bui. No. 41, Hyg. Lab., IT. S. Pub. Health 
and Mar. Hosp. Serv., Wash., 1908, p. 163. 

(739) 



740 

duced into the body, too little attention has been given to the ques- 
tion of the number of bacteria in top milk when used for infant 
feeding. Oftimes when infants are taken off breast milk and put on 
modified cow's milk made from top milk it is found that, in spite of 
various modifications containing varying percentages of proteid, the 
milk fails to agree with the infant. In those cases which develop 
diarrhea the fault may not be in the proteid, but in the large number 
of bacteria in the top milk used for the preparation of the formula. 

The greater frequency of intestinal tuberculosis in young children 
may be due, not alone to the fact that they use a large amount of 
milk, but because top milk, which contains more tubercle bacilli per 
cubic centimeter than the whole milk, is used in the preparation of 
modified milk formulae. 

The literature upon the subject of the relative number of bacteria 
in top milk and in bottom milk is very slight. None of the writers 
seem to have realized the great importance of the subject in its rela- 
tion to infant feeding. 

In 30 samples of milk examined the average number of bacteria 
in gravity-raised cream was 69,211,000 and in the sediment layer 
4,360,000 bacteria per cubic centimeter. 

In 26 samples of milk the average number of bacteria in gravity 
and centrifugally raised cream in the sediment and in the mixed milk 
was — 



Gravity. 


Centrifugalized. 


Whole milk. 


Cream layer. 


Sediment 
layer. 


Cream layer. 


Sediment 
layer. 


68,690,000 


4,840,000 


96, 840, 000 


18,840,000 


14,388,000 



In 6 samples of milk the average relative number of bacteria in 
the gravity cream was 15,416,000; skim milk, 2,050,000; in the sedi- 
ment layer, 1,405,000; and in the whole milk, 2,708,000. 

In 7 samples of milk the average relative number of bacteria in 
the centrifugally-raised cream was 4,500,000; in the sediment layer, 
725,900; in the skim milk, 119,700; and in the whole milk, 619,800. 

One sample of milk contained 500 times as many bacteria per cubic 
centimeter in the cream as in the bottom milk. 

When milk is centrifugalized the great mass of bacteria go up with 
the cream; a lesser number is carried down in the sediment. The 
skim milk contains many times fewer bacteria per cubic centimeter 
than the cream or sediment layers. 

Centrifugally-raised cream contains more bacteria per cubic centi- 
meter than the gravity-raised cream from the same milk. 



25. NATIONAL INSPECTION OF MILK. 



(741) 



NATIONAL INSPECTION OF MILK. 



By Harvey W. Wiley, M. D., Ph. D., 

Chief Bureau of Chemistry, Department of Agriculture. 



Much can be done in improving the character of milk by inspec- 
tion under the national law of June 30, 1906. This law applies only 
to milk sold in the District of Columbia and the Territories and the 
milk entering into interstate commerce. There are, however, many 
large cities located on or near the boundaries of States, and in these 
cities a large part of the milk supply comes from without the State 
in which they are situated. New York, Philadelphia, Cincinnati, 
Louisville, Chicago, St. Louis, and Kansas City are types of cities 
of this class. Under the provisions of the law steps have been taken 
to determine the character of the milk supply furnished some of 
these cities, in so far as its chemical composition is concerned and 
incidentally the inspection of dairies has necessarily been made. In 
all, about 3,500 samples of milk have been secured and examined. 
The number of producers, however, was not so great, as often a 
great number of samples were obtained from one producer. The 
manner of conducting the milking and the shipping of milk into 
various cities was studied and in all cases where samples were col- 
lected for prosecution the inspectors accompanied the shipments, 
riding in the milk cars so as to be certain to maintain the identity of 
the samples and to be able to swear to their genuineness after they 
had crossed the State lines. The samples were at once taken to the 
local laboratories of the Bureau of Chemistry, in the cities mentioned, 
and subjected to a preliminary examination, and those which showed 
adulteration or misbranding were afterwards submitted to a more 
careful examination in order to establish with certainty a case suffi- 
ciently strong to warrant prosecution. It was deemed wise to prose- 
cute only the flagrant cases, but many samples were found by analysis 
to be watered or partly skimmed, and these were not prosecuted be- 
cause of the difficulty which it was thought would arise in proving 
conclusively to the jury that the milk had been tampered with. 

Owing to the necessary delay in the prosecution of cases in the 
Federal courts only 57 cases so far have gone to trial. Of these, 53 

(743) 



744 

entered a plea of guilty of watering or skimming or both, 1 of 
adding a preservative, 1 of watering and adding a preservative, 1 
was convicted of adding water, and another charged with the same 
offense was acquitted by the jury. A curious incident is connected 
with this, in that the case in which the jury acquitted the defendant 
was the most flagrant, while the case following was a much less 
flagrant case of watering. 

In the case in which the verdict was rendered for acquittal the 
milk was grossly adulterated and practically no evidence was sub- 
mitted by the defendant. The evidence submitted by the Govern- 
ment was strong and well connected and proved without a shadow of 
a doubt the adulteration charged, namely, both watering and skim- 
ming. The chemical evidence in this connection was exceptionally 
strong and convincing. Sixteen additional flagrant cases have been 
reported to the district attorney in Illinois regarding samples shipped 
from Illinois into St. Louis. In 2 cases it was found by analysis that 
the milk was skimmed and in 14 watered. Twenty-six cases have 
been reported to the district attorney in the cities adjoining Chicago 
for prosecution for adulteration and misbranding milk sent into that 
city ; 12 of these were found to be skimmed, and 14 watered. Sixty- 
two cases have been reported to the district attorney in Kentucky and 
Indiana adjoining Cincinnati, and 9 cases in Kansas City. It is evi- 
dent that if a jury is made up of those who produce, it is hard to get 
a conviction. In addition to the 113 cases which are of the strongest 
possible character on which conviction could be easity secured a much 
larger number is evidently adulterated by skimming or misbranding, 
but these were not reported for trial. When very rich milk is watered 
or partly skimmed and the resulting fat content is still well above the 
standard, only very strong evidence is likely to convict. The general 
result has shown that a large percentage of the milk going into some 
of our great cities is either watered or skimmed, or both. It is very 
gratifying, however, to find from the investigations that almost no 
milk samples have been treated with preservatives. 

It is evident from the above brief summary that the national law 
is to be a great help to the state and municipal authorities in con- 
trolling adulterations and misbranding of milk. 



26. THE MUNICIPAL REGULATION OF THE MILK 
SUPPLY OF THE DISTRICT OF COLUMBIA, 



(745, 



THE MUNICIPAL REGULATION OF THE MILK SUPPLY OF THE 
DISTRICT OF COLUMBIA." 



By Wm. Creighton Woodward, M. D., LL. M., 

Health Officer of the District of Columbia. 



I. THE DEVELOPMENT OF THE MILK-INSPECTION SERVICE. 

Milk is a food. Legislation for the regulation of the milk supply 
is enacted with that fact in mind, and not infrequently legislation 
relating to the manufacture and sale of foods generally is applicable 
as a whole or in part to the production and sale of milk. For these 
reasons it has been deemed expedient in discussing the municipal 
regulation of the milk supply to refer rather oftener to the regula- 
tion of the general food supply than otherwise would have been 
necessary. It is interesting, too, to note how changes in our modes 
of living, or increasing knowledge with respect to the sanitary and 
mercantile relations of foodstuffs, have altered our practice with ref- 
erence to governmental supervision and control. The inspection of 
flour, of salted provisions, of tobacco, and of spirituous liquors, in the 
cities of Washington and Georgetown, in the District of Columbia, 
was early provided for, but the regulation of the sale of fresh meats 
and of milk is of comparatively recent origin. 

The first legislation relating to the sale of milk of which I have 
been able to find record was enacted by the board of aldermen and 
board of common council of the city of Washington on August 1, 
1863. The ordinance was entitled, "An act in relation to cows," and 
seems to have been directed rather against the nuisance liable to arise 
from the keeping of cows than against any supposed effect which in- 
sanitary conditions in and about cow yards, pens, and stables might 

a For the information of readers not familiar with the administration of 
municipal affairs in the District of Columbia, a memorandum descriptive 
thereof is appended. (See page 789.) 

(747) 



748 

have upon the milk issuing therefrom.® Apparently, however, it 
was construed to prevent the selling of milk under certain conditions 
since we find enacted by the sixty-third council, on May 24, 1866, an 
act entitled, "An act explanatory of the act entitled, 'An act in rela- 
tion to cows,' approved August 1, 1863," which provided simply that 
the first section of the earlier act should be so construed as to permit 
the selling of milk by persons who keep one or two cows. 6 The situa- 
tion in Georgetown, then a separate corporation, must have been 
similar to that existing in Washington, for on April 22, 1865, the 
board of aldermen and board of common council of the corporation 
of Georgetown enacted an ordinance substantially the same as that 
previously enacted by the corporation of Washington, but further 
provided that no person should be permitted to feed or milk a cow on 
any of the public streets or footways of the city. c 

The next record of action looking toward the regulation of the 
food supply of the District of Columbia appears in the act of Con- 
gress, entitled "An act to provide a government for the District of 
Columbia," approved February 21, 1871, which, as an incident to the 
general reconstruction of the local government, created a board of 
health and in terms made it the duty of that board to prevent the 
sale of unwholesome food in the cities of Washington and George- 
town.^ This board seems to have proceeded with admirable prompt- 

a An act in relation to cows. 

Be it enacted by the board of aldermen and board of common council of the 
city of Washington, That from and after the first clay of October, eighteen 
hundred and sixty-three, it shall not be lawful for any person or persons to 
keep, provide for, or maintain within the limits of the city of Washington, a 
cow yard, pen, or stable for dairy or other purposes, nearer than two hundred 
feet of any dwelling house, other than the dwelling house of the owner or 
keeper of such yard, pen, or stable, under a penalty of not less than one nor 
more than five dollars for each day's offense so continued ; to be prosecuted 
and recovered as other fines and penalties due the corporation are prosecuted 
and recovered : Provided, however, that nothing herein contained shall apply 
to persons who keep but two cows for their own immediate use. 

Sec. 2. And be it further enacted, That the owner or keeper of any cow yard, 
pen, or stable, or other place where cows are kept, within the limits of the city 
of Washington, shall daily remove the filth from and keep clean such yard, pen, 
stable, or other place, under a penalty of not less than one or more than five 
dollars for each and every offense; to be recovered as provided for in the first 
section of this bill. 

The commissioners of the several wards and police officers of the city are 
instructed to report and prosecute any and every infringement of this act. 

Approved August 1, 1S63. — (Laws of the corporation of the city of Wash- 
ington passed by the sixty-first council, chap. 4.) 

b Laws of the corporation of the city of Washington, passed by the sixty- 
third council, chap. 27. 

c Ordinances and resolutions of the corporation of Georgetown, 3,865, page 24. 

d 16 Stat L., 424. 



749 

ness and energy to the discharge of its duties, for on May 15, 1871, 
within about five weeks after the day of its organization, the board 
took steps to prevent the sale of unwholesome food in the cities of 
Washington and Georgetown by enacting an ordinance for that 
purpose. This ordinance in so far as it relates to the sale of milk 
was as follows: 

Sec. 2. And be it further ordained and enacted, That no person shall manu- 
facture, prepare, or sell any liquor used for drink, whether malt vinous, or 
ardent, or milk of cows or goats, intended to be used as food or drink, which 
has been adulterated with any poisonous or deleterious ingredient ; and any 
person violating the provisions of this section shall, upon conviction, be pun- 
ished by a fine of not less than fifty nor more than five hundred dollars for 
each and every such offense. 

* * >:< * * >:< * 

Sec. 7. And be it further ordained and enacted, That no person shall offer 
for sale, or keep for such purpose, any unwholesome, watered, or adulterated 
milk, or swill milk, or milk from cows kept up and fed on garbage swill or 
other deleterious substance ; nor shall any person make for sale any butter or 
cheese from such unwholesome milk ; and any person violating the provisions 
of this section shall, upon conviction, be punished by a fine of not less than five 
nor more than twenty-five dollars for each and every such offense. Passed 
May 15, 1871. a 

Strange as it may seem to the sanitarian of to-day, and yet appa- 
rently quite in keeping with the then prevailing ideas, while this ordi- 
nance very clearly and positively required that places where meat and 
vegetables were sold for food should be kept in a clean and whole- 
some condition, and that meat and vegetables should not be allowed 
to become poisoned or infected or unfit for food, no such provision 
was enacted with respect to the sale of milk. The board of health 
held, however, advanced ideas with respect to the production of milk 
for sale and in its first annual report says : 

The proper diet of cows is also a measure of vital moment to that large class 
of infants and others who subsist chiefly on milk and its preparations. The 
deterioration of this most nourishing secretion by swills and other nefarious 
compounds has, in our large cities, vastly increased the percentage of deaths 
from diarrhea and cholera infantum. 6 

In the second annual report of the board of health, under date of 
October, 1873, the food inspectors in the service of the board, Messrs. 
William Wolf and Eobert Wilson, and Dr. Charles Allen, drew atten- 
tion to the importance of a good milk supply. These inspectors seem 
to have realized even then the importance of the inspection of milk 
at the place of production, a feature of milk-inspection service that 
on the part of sanitarians generally did not receive the consideration 
that it deserved until about twenty years later. Their practical expe- 

° Report of Board of Health, 1872, pp. 63, 64. 
6 Report of Board of Health, 1872, p. 18, 



750 

rience must have taught them, too, the only way in which the milk 
supply of the District could ever be controlled at its source, viz, by a 
system of permits or licenses, a method which was adopted in the Dis- 
trict in 1895 and which has since come into more or less general use 
throughout the country. What these men say with respect to this 
matter, in view of the time when it was said, is well worth quotation 
at length : 

The milk supply of this District is from dairies established in the county, 
and in the neighboring States of Virginia and Maryland; and as a proper 
inspection would include the examination and sanitary control to some extent 
of the dairies, as well as the milk when offered for sale here, we recommend 
that the board require dealers to procure permits before they can dispose of 
their milk here. By this means supervision might be obtained over them, even 
in Virginia and Maryland, and we doubt not that the dairymen would readily 
adopt suggestions looking to the proper preservation of their milk from un- 
healthy contaminations. 

And the then health officer, Dr. P. T. Keene, in submitting to the 
board of health the report of the food inspectors, recommended that 
" the regular inspection of dairies and the requirement of licenses to 
vendors of milk under strict provisions should at once be instituted." 6 

In its third annual report, covering the year ending September 30, 
1874, the board of health published a statement by Dr. B. F. Craig, 
its chemist, who had analyzed a number of samples of milk, most of 
which, said Doctor Craig, " appeared to have some portion of the 
cream removed, or else to have been originally of poor quality." 
After commenting upon possible sources of error in the use of the 
lactometer and upon the importance of chemical examination, he 
adds: 

but before chemical examination can produce any effect there should be a 
legal definition of the character of what can be sold as milk and what may be 
sold as skimmed milk, and, I would suggest, of what may be sold as cream. 
The law can at present take hold of nothing but the proved addition of water 
or other adulterants. It should also be made to cover the case of removal of 
cream, and in fact to exclude from the market all milk below a certain quality, 
that quality being determined by the amount of water in the milk and the 
amount of fatty matter or cream to be obtained from it. c 

The health officer, in his report to the board of health for 1875, 
again calls attention to the importance of inspecting milk at the 
places of production: 

For meats and milk, per example, the most important of all, we are entirely 
at the mercy of the producers, and must continue so to be until the abattoir, 
or some other system, be established by which it may be possible to inspect 
every animal at the time of slaughtering, and until some carefully organized 
plan of checking adulteration of milk be inaugurated. * * * And this I find 

° Report of Board of Health, 1872, p. 124. 
6 Report of Board of Health, 1872, p. 121. 
c Report of Board of Health, 1874, pp. 206, 207. 



751 

is the principal acted upon in many of the European cities. Aiming to control 
the fountains of supply, the authorities largely prevent deleterious and adul- 
terated food from reaching the hands of the retailers.^ 

The board of health, in its annual report for 1877, the last report 
it was ever to issue, again called attention, but only in a general way, 
to the importance of supervising the sale of milk, and particularly 
to the relation between the production of milk under insanitary con- 
ditions and the unwholesomeness of the article produced. 6 

For several years past the board of health had had the services of 
an analytical chemist to assist it in procuring and maintaining the 
purity and wholesomeness of the food supply, but with the advent of 
the fiscal year 1876-77 his name disappears from the records. The 
situation is graphically shown in a resolution that appears in the 
minutes of the board for June 30, 1876 : 

On motion of Professor Langston it was ordered that all employees of the 
board except the poundmaster and the force serving under him be discharged 
to take effect this day. 

The board of health was being strangled to death by the withdrawal 
of the funds necessary for its operations. Arrangements were made 
for the continuance of the work of the board with a very much re- 
duced force, but the board died on June 11, 1878. No provision was 
ever again made for the appointment of an analyst for the board or 
for its successor, the health department, until July 28, 1892. In the 
meantime, in so far as related to the analysis of foods and other ar- 
ticles, the board of health and the health officer had to rely on such 
outside assistance as they might be able to obtain. Although it had 
been charged, by law, with the duty of preventing the sale of un- 
wholesome food in the cities of Washington and Georgetown, and 
endowed with broad legislative power, no action seems ever to have 
been taken by the board to regulate the milk supply of these cities 
further than to promulgate the ordinance of May 15, 187l, c and to 
enforce that ordinance in such manner as its available force would 
permit. There had been much in the way of suggestion and recom- 
mendation for improvement, but nothing in the way of action. The 
time was not yet ripe. 

The board of health of the District of Columbia became extinct 
with the passage of an act entitled " An act providing a permanent 
form of government for the District of Columbia," approved June 
11, 1878, and its legislative power died with it. The new law pro- 
vided, with respect to the board of health, as follows : 

That in lieu of the board of health now authorized by law, the Commissioners 
of the District of Columbia shall appoint a physician as health officer, whose 

a Report of Board of Health, 1875, p. 72. 
6 Report of Board of Health, 1877, p. 33. 
c See page 749. 



752 

duty it shall be, under the direction of the said Commissioners, to execute and 
enforce all laws and regulations relating to the public health and vital sta- 
tistics, and to perform all such duties as may be assigned to him by said Com- 
missioners ; and the board of health now existing shall, from the date of the 
appointment of said health officer, be abolished.® 

Although the act itself set forth that the health officer should be 
appointed in lieu of the board of health, as a matter of fact his duties 
were substantially the same as those of the health officer, who had 
previously operated under the direction of the board of health; the 
Commissioners of the District were in fact, if not in law, the suc- 
cessors to the board of health. Neither the Commissioners nor the 
health officer, however, were authorized to promulgate regulations 
relating to public health, but were authorized merely to operate under 
such laws and regulations relating to such matters as were then in 
force or might thereafter be enacted by Congress. And Congress, 
having assumed by the act of June 11, 1878, exclusive legislative 
control of the food supply of the District, made its first move toward 
that end on January 25, 1879, by passing an act entitled "An act for 
the protection of dairymen, and to prevent deception in sales of butter 
and cheese in the District of Columbia. 6 The act, as its title imports, 
was solely for the protection of dairymen against unfair competition 
resulting from the fraudulent sale of oleomargarine in the District 
of Columbia and for the protection of the community from such sales. 
It had no relation whatsoever to matters of health, and frankly per- 
mitted the sale of oleomargarine when properly marked. 

The validity of the ordinances of the defunct board of health ap- 
pears to have been soon questioned, and on April 24, 1880, Con- 
gress, by a joint resolution entitled, " Joint resolution legalizing the 
health ordinances and regulations for the District of Columbia," 
legalized certain of the ordinances enacted by the board of health, 
among them an ordinance to prevent the sale of unwholesome food in 
the cities of Washington and Georgetown. These ordinances and 
the ordinances relating to the location and keeping of cow yards, pens, 
and stables, previously enacted by the boards of aldermen and com- 
mon councils of the corporations of Washington and Georgetown, rep- 
resented at this time the entire body of law in force in the District of 
Columbia relating to the production and sale of milk. Crude as it 
appears, it was probably in keeping with the then prevailing ideas 
concerning the regulation of the production and sale of this food, 
although it was very far behind the needs of the situation, as viewed 
by the board of health itself and as set forth in its several annual 
reports. 

a 20 Stat. L., 107. 
6 20 Stat. L., 264. 
c 21 Stat. L., 304. 



753 

All questions relating to the production and sale of milk seem to 
have been in abeyance, and the dairy farmer and the milk dealer, the 
sanitar}^ authorities, and the consumer of milk rested content with 
existing conditions until the fiscal year 1882-83. We find then, 
in the rejDort of the health officer, Dr. Smith Townshend, for 1883, the 
following suggestion, contained in a report by Dr. B. G. Pool, medi- 
cal sanitary inspector. The statement refers ^to certain investigations 
that Doctor Pool had made to ascertain the causes of cases of diph- 
theria, scarlet fever, and typhoid fever : 

On inquiry as to the source of milk supply, it was found that many persons 
were unable to give the name or residence of their milkman, seeming to con- 
sider themselves fortunate if they were able to secure the service of a " country- 
man." It is suggested as desirable that some provision should be made for the 
regular inspection of the sources of milk supply, not only as to the quality of 
the milk itself, but that inquiries be made to ascertain the prevalence of con- 
tagious diseases among the families of the milkmen.® 

Although no record appears of any effort having been made to pro- 
cure the enactment of the legislation necessary for the establishment 
and maintenance of a system of milk inspection embodying the super- 
vision and control of places of production and sale, yet the health 
officer imdertook in the following year to inspect the dairy farms from 
which the milk supply of the community was drawn. In his report 
for 1883-84, after recounting certain facts tending to show the im- 
portance of the proper supervision of the milk supply, he says: 

With such facts as these before us it becomes apparent that in making an ex- 
amination to ascertain as to the comparative purity or impurity of the milk 
supply of a city the health officer must go farther than the making of an analy- 
sis of samples of the various milks sold. His influence must be felt by the pro- 
ducer as well as by the middleman who comes between the producer and the 
consumer. 

The entire subject is discussed in a thoroughly scientific spirit, but 
the report does not set forth with any satisfactory detail the results 
of the investigation which was made, nor does it appear that any ac- 
tion was taken even at this time looking toward the establishment of a 
proper milk-inspection service. & The health officer, like his forerun- 
ner, the board of health, was moving in advance of the times. 

Current* reports in the spring of 1888 seem to have alleged the 
prevalence of adulteration of food and drink in the District, for 
on April 10, 1888, the health officer calls attention of the Commis- 
sioners to the fact that the health department is without an analyst, 
and in his annual report for that year he states that the inspector 
of asphalts and cements of the engineer department, who has been 
analyzing for the health department certain samples submitted to 

° Report of the Health Officer, 1882-83, p. 39. 
& Report of the Health Officer, 1883-84, pp. 15 et seq. 
45276 c — Bull. 56— 12— -4S 



754 

him, had very much reduced, and would probably further reduce, 
the amount of work which he performed for the health department. 
The appointment of a chemist for the health department was recom- 
mended- a On the 12th of October, of the same year, the first serious 
effort to regulate the food supply of the District of Columbia that 
had ever been made consummated in the enactment by Congress 
of an act entitled, "An*act to prevent the manufacture or sale of 
adulterated food or drugs in the District of Columbia." & 

The food and drugs act of October 12, 1888, was broad in its 
character, seeking to prevent within the District of Columbia the 
adulteration of foods and drugs generally. The term " food," as 
used in the act, was defined, however, to include every article used 
for food or drink by man, other than drugs or water, and therefore 
included milk. The general direction and control of the enforce- 
ment of the act were entrusted to the Commissioner of Internal Reve- 
nue; it was specified that the analysis provided for in the act should 
be under the control of the Commissioner of Internal Revenue, under 
such rules and regulations as might be prescribed by the Secretary 
of the Treasury, and the Commissioner of Internal Revenue was 
vested with authority even to declare certain articles or preparations 
to be exempt from the provisions of the act. By virtue of authority 
conferred by this act, the Secretary of the Treasury, under date of 
November 20, 1888, promulgated certain regulations concerning 
analysis of foods and drugs in the District of Columbia. He under- 
took to fix standards for certain specified foods, among them milk, 
and specified certain substances as " known to be injurious to health 
when present in foods." Others he described as " known to produce 
more or less toxic effects, and whose use in food is therefore harm- 
ful." Other substances were designated as " harmless coloring 
matters." The standard fixed for milk was as follows : 

Milk: Whole (pure) milk, the minimum specific gravity, "actual density/' 
shall be 1.030 at 60° F., and the milk shall contain uot less than 13 parts 
in 100 of solids, as follows : Fat, 3.5 ; solids, not fat, 9.5 ; water, not more than 
87. The removal of cream, the addition of water, foreign fats, or coloring 
matter will be considered adulterations. 

A form was provided upon which any person entitled under the 
law to have a sample of any food or drug analyzed might make 
application to the Commissioner of Internal Revenue for that pur- 
pose. It was required that applications be made in triplicate, one 
to be returned to the applicant with the report of the analyst, 
another to be filed with the United States district attorney, and 
the third to be retained by the Commissioner of Internal Revenue. 

a Report of the Health Officer, 1887-88, pp. 24, 25. 

6 25 Stat. L., 549. 

* Instructions to Internal Revenue Officers, Series 7, No. 15, Nov. 20, 1888. 



755 

The means had been provided by which any interested person, 
whether a mere private purchaser or a representative of the health 
department, could procure an analysis, the ordinary purchaser under 
any circumstances, but the representative of the health department 
only when he suspected that the sale had been made in violation 
of law. Further than this nothing was done. The Commissioner 
of Internal Revenue waited for the health officer. The health officer 
waited for the Commissioner of Internal Revenue. The result was 
inevitable. 

In his report for 1889, the Commissioner of Internal Revenue 
writes : 

No samples were submitted to me for analysis as provided by that act (act of 
October 12, 1888). This office is of the opinion that the failure to forward 
samples of suspected food for analysis may be ascribed to the apathy of the 
general public and that of the health department of the District of Columbia. 

One sample was received in 1891, but the nature or origin of it is 
not set forth. Two samples of milk were analyzed in 1892, but as to 
the origin the report is silent, 5 

The act making appropriations for the expenses of the District of 
Columbia, approved July 14, 1892, authorized the appointment of 
" one sanitary and food inspector, who shall also inspect dairy prod- 
ucts and shall be a practical chemist." On July 28, of the same year, 
John D. Hird was appointed and entered upon the discharge of his 
duties. The makeshift for a chemical laboratory that was then pro- 
vided was not ready for use until December, but no effort was made 
even during the interval to operate under the food and drugs act of 
October 12, 1888. c After the laboratory was ready for use successful 
prosecutions were brought under District ordinances, for the sale of 
colored milk and of milk that had been watered, but it was found that 
these ordinances provided no penalty for the sale of skimmed milk. 
Recourse was thereupon had to the act of Congress of October 12, 
1888, relating to the manufacture and sale of adulterated foods and 
drugs in the District of Columbia, and to facilitate the operations of 
the health officer, the Secretary of the Treasury designated the chem- 
ist of the health department as an analyst to make analyses under the 
provisions of that act.^ The Commissioner of Internal Revenue, in 
his report for 1894, writes: 

The act of October 12, 1888, to prevent the manufacture or sale of adulter- 
ated foods or drugs in the District of Columbia, imposes upon this office the 
duty of analyzing all samples submitted for decision as to their character. 
No provision has been made, since the first year of its passage, for increasing 

a Report of Commissioner of Internal Revenue, 1889, p. 175. 
6 Report of Commissioner of Internal Revenue, 1892, p. 205. 
c Report of the Health Officer, 1893, p. 10. 

d Report of the Health Officer, 1893, pp. 10, 11. Instructions to Internal 
Revenue Officers, Series 7, No. 15, Revised, p. 9. August 10, 1893. 



756 

the force or equipment of this division, in connection with the execution of 
the law and heretofore no such increase has been necessary as no effort has 
been made to enforce it, consequently few samples have been presented. In 
consequence of a more active supervision of the milk supply in Washington 
by the local health authorities, however, a number of samples of milk were 
presented to this office during August and September, 1893, for decisions as 
to their adulteration under the provisions of this law. As the time required 
for the analysis Of these samples and for the rendering of expert testimony 
thereon in court threatened to interfere seriously with the regular work of 
the division, revised regulations were issued (Series 7, No. 15 revised) pro- 
viding for the analysis of all such samples by the chemist of the health office 
of the District of Columbia, under the control and supervision of this office. 

Reports were accordingly received from this officer from September, 1893, 
up to the close of the fiscal year, of the analysis of 17 samples — 15 of milk, 1 of 
butter, and 1 of granulated sugar — all of which were decided to be adulterated 
and so certified to the district attorney for the District of Columbia. I would 
suggest in this connection that Congress be asked to either provide the facili- 
ties necessary for the analysis of all samples in the laboratory of this office, or 
to so amend the law as to relieve me entirely from any connection with its 
execution.® 

After the amendment of the regulations, samples of milk and of 
other articles of food were collected by agents of the health depart- 
ment and duly analyzed by the chemist. If the result warranted a 
prosecution, the usual form of application for analysis and certifica- 
tion, provided by the Commissioner of Internal Revenue, was made 
out in triplicate, the report of the analyst being filled in by the chem- 
ist of the health department. After such application had been duly 
certified, one copy was filed with the district attorney and the prose- 
cution was duly proceeded with. The method was cumbersome and 
lacked the directness essential to the efficient enforcement of a statute 
by criminal procedure. Reference of the case to the Commissioner of 
Internal Revenue was a mere form, since the findings of the chemist 
of the health department were not verified in the office of the Commis- 
sioner by independent analysis, nor was the vendor given an opportu- 
nity to be heard. The enactment of this law was, however, of impor- 
tance as marking a definite effort toward the proper control of the 
food supply of the District of Columbia and marking also the estab- 
lishment by regulation of a standard for "whole (pure) milk." The 
chemist of the board of health had recommended the establishment of 
such a standard on November 10, 1874 ; & its establishment became an 
accomplished fact on November 20, 1888. c It can hardly be said 
that any undue haste was displayed with respect to the matter. 

The possible relation between the milk supply and the prevalence 
of typhoid fever in the District of Columbia appears to have been 
called directly to public attention for the first time, by Prof. J. D. 

° Report of Commissioner of Internal Revenue, 1894, page 197. 

*> Report of Board of Health, 1874, p. 207. 

c Instructions to Internal Revenue Officers, Series 7, No. 15, p. 13. 



757 

Hird, chemist of the health department, in his report for the year 
ending June 30, 1893. Professor Hird said : 

While the effect of lowering the nutritive value of the milk, either by the 
addition of water or the removal of cream, can be readily comprehended, yet 
this becomes of secondary importance when we compare this with milk that 
contains the germs of typhoid and scarlet fever, diphtheria, and tuberculosis in 
its various forms. Some of these germs grow rapidly in milk without produ- 
cing any visible effect. The germs of typhoid fever, tuberculosis, and diphtheria 
may thus grow and be consumed with the milk without our knowledge. The 
tests ordinarily applied fail to detect the specific germs of these diseases. 
* * * 

Some of the common putrefactive bacteria give rise to poisons while growing 
in this fluid. * * * Cleanliness and care, therefore, become of the most 
vital importance in the handling of the milk and cans in which the milk is con- 
veyed, while clean stables, pure air and water are as necessary to the animal 
as to the human being. 

The then health officer, Dr. C. M. Hammett, in commenting upon 
the prevalence of typhoid fever at that time, stated that in some cases 
the disease had prevailed in families who used water from the same 
well, and in others where families received their milk from the same 
cows, and recommended the close and frequent inspection not only of 
milk and the dairy establishments which supply it, but also of the 
cattle composing the herd. This subject, said Doctor Hammett, is now 
receiving the earnest attention of the health department, with a view 
to the making of an intelligent and effective recommendation to the 
Commissioners and to Congress. 

About July, 1893, Dr. E. C. Schroeder, of the Bureau of Animal 
Industry, began an investigation into the milk supply of the District 
of Columbia. Between July 12, of that year, and April 19, 1894, 18 
samples of milk were collected, as delivered to private residences or 
as bought in the stores of this city, and 1 was obtained from a herd 
in Virginia. Specimens from these 19 samples were injected into the 
peritoneal cavities of 40 guinea pigs, and in 1 case tuberculosis re- 
sulted. 6 The investigation made by Doctor Schroeder included the 
examination of many dairy cows supplying milk to this city, and out 
of over 800 examined between 5 and 6 per cent had defective udders. 
Referring to the investigation then being made, and particularly to 
the application of the tuberculin test, the Chief of the Bureau of 
Animal Industry wrote, apparently in the fall of 1894, as follows : 

The testing of cows with tuberculin in the District of Columbia is now in 
progress, but has been commenced in a small way in order to develop a satis- 
factory plan of operations. About 125 cows have been tested, and 20 per cent of 
these were found to be affected. 

« Report of the Health Officer, 1893, pp. 9 to 12. 

& Bureau of Animal Industry, Bulletin No. 7, published in 1894, pp. 77 to 81. 

c Bureau of Animal Industry, Bulletin No. 7, published in 1894, p. 87. 



758 

I would now recommend a larger force and more vigorous operations. With 
the present force and facilities, but a few thousand dollars can be used during 
the year out of the $100,000 appropriated for this purpose. With twice as many 
men and better facilities for getting over the ground several times as much 
work can be accomplished. 

As tuberculous cows are taken out of the dairies new animals must be put 
into their places, and it is desirable that these should be tested before they are 
allowed to enter the stables which have been disinfected and freed from dis- 
ease. To do this at present the herd inspection must be interrupted, and as 
the number of inspected herds increases the interruptions will be more fre- 
quent, until the herd inspection will be entirely stopped. It is important, 
therefore, that men should be stationed at the stock yards to test all cows that 
are brought into the District. This will prevent the further introduction of the 
disease, and will enable us to keep free from it the herds which have already 
been inspected. 

This work in the District is of great importance, not only as a preventive of 
disease among consumers of meat and milk, and to guard against the spread of 
tuberculosis from the District into adjoining States as required by law, but as 
an experiment to determine various questions relating to the prevalence, recog- 
nition, and prevention of tuberculosis as affecting dairy stock. The scientific 
results of this work are, therefore, of great value to the whole country, while 
the practical work is of benefit to only a small section. These scientific results 
nre urgently needed in order that the various States may formulate proper 
measures for protecting their citizens, and for that reason, if for no other, the 
work should be pressed to early completion. 

Under any circumstances only a small part of the amount appropriated can 
be expended during this fiscal year, as one-third of the year has already 
elapsed. More rapid work also means more thorough work. There is less op- 
portunity to shift diseased cows from the uninspected to the inspected dairies, 
and the first inspection should be completed before a second one is necessary. 

Detailed recommendations as to requirements will be made from time to 
time as occasion demands. 

No record has been found to show what further recommendations, 
if any, the Chief of the Bureau of Animal Industry made concerning 
the application of the tuberculin test to dairy cattle in the District 
of Columbia, nor to show even why the work that had been begun 
was abandoned. The reference to " the $100,000 appropriated for this 
purpose," apparently meaning thereby for the testing of dairy cows 
in the District of Columbia with tuberculin, is misleading. A care- 
ful investigation has failed to show that Congress ever made an 
appropriation for the purpose named. It is probable that the 
amount stated was an amount set aside, formally or informally, 
by the Secretary of Agriculture, for the eradication of tubercu- 
losis from the District, from the gross sum appropriated for the 
expenses of the Bureau of Animal Industry during the fiscal year 
1895. The appropriation act for the year named 6 authorized the 

a Tenth and Eleventh Annual Reports, Bureau of Animal Industry, 1893-94. 
Published in 1896. Pages 32 and 33. 
»Act of August 8, 1894, 28 Stats., 269. 



759 

Secretary of Agriculture to use any part of the money appro- 
priated for the salaries and expenses of the Bureau of Animal Indus- 
try, $800,000, that he might deem necessary or expedient and in 
such manner as he might think best, to prevent the spread of pleuro- 
pneumonia, tuberculosis, sheep scab, and other diseases of animals, 
and to expend any part of the appropriation in the purchase and 
destruction of diseased or exposed animals and the quarantine of the 
same whenever in his judgment it might be necessary to prevent the 
spread of- such diseases from one State to another. The authority 
of the Secretary of Agriculture to set aside $100,000 for the eradica- 
tion of tuberculosis from the District of Columbia under the terms 
of this act seems to have been ample. The fact that this appropria- 
tion was made to apply specifically to tuberculosis, whereas preceding 
appropriation acts had not named this disease, suggests that Congress 
may have had in mind when it was made the inauguration of active 
operations toward the eradication of tuberculosis. 

Whether the work done by the Bureau of Animal Industry in the 
District of Columbia during 1893 and 1894 was prompted by the then 
recent discovery of tuberculin and the announcement of its properties 
and uses, or was begun because of the general sanitary awakening 
that had been brought about by the dread lest Asiatic cholera, then 
prevailing in certain parts of Europe, should gain entrance and foot- 
hold in this country, the record does not disclose. The latter circum- 
stance, however, was a potent factor in creating a popular sentiment 
favorable to sanitary improvement. In this District an organization 
denominated the Sanitary League was formed and popular lectures 
on subjects related to hygiene and sanitation were held. In the fall 
of the year appeared the first report of the then newly appointed chem- 
ist of the health department showing the utter inadequacy of existing 
legislation for the protection of the milk supply. a The time for 
action had come. The Commissioners asked the cooperation of the 
Medical Society of the District of Columbia in framing necessary 
legislation, and the society promptly appointed a committee, consist- 
ing of Drs. C. H. A. Kleinschmidt, S. S. Adams, and W. C. 
Woodward, to investigate the subject and to report to the society. The 
report of this committee was submitted on June 13, 1894, and em- 
bodied a draft of the proposed bill. The report was approved, and 
the proposed bill forwarded to the Commissioners, but the session of 
Congress had advanced so far that favorable action was impossible. 
The legislation suggested was later approved by Dr. D. E. Salmon, 
then Chief of the Bureau*of Animal Industry, Department of Agri- 
culture. It became a law on March 2, 1895, under the title of "An 
act to regulate the sale of milk in the District of Columbia, and for 

a Report of the Health Officer, 1893, pages 9 to 12. 



760 

other purposes," only two amendments tending seriously to impair 
its usefulness from an administrative standpoint having been made. 
The food inspectors in the service of the board of health had, in 
October, 1873, recommended that persons selling milk in the District 
of Columbia be required to obtain permits in order to obtain a basis 
for the proper inspection of places where milk was produced and 
sold, and of the cattle from which it was drawn. The milk law of 
March 2, 1895, had now accomplished that end. 

The new law marked a departure in milk legislation from estab- 
lished lines. Theretofore it had been deemed sufficient to examine 
milk as it appeared in the market. Now it was proposed to begin 
at the cow. Previously it had been regarded as beyond the power 
of the community to go outside of its territorial limits to control the 
methods employed in the production of its food supply. Now it was 
proposed to say to the producer, no matter where located, " The milk 
sold in our jurisdiction must come from places that conform to certain 
requirements, as determined by inspection by our own agents. If you 
wish to sell milk of this kind, and none other can be sold in our city, 
we will, if you desire and request it, inspect your establishment for 
you." It must be admitted that the District of Columbia was in one 
way peculiarly well situated to attempt such a departure from estab- 
lished law and practice ; for while by far the larger part of its milk 
supply comes from the States of Maryland and Virginia, yet any law 
that might be enacted must emanate from Congress, vested not only 
with the right to exercise exclusive legislation in all cases whatsoever 
over the District of Columbia, but also with the right to regulate in- 
terstate commerce. Such a statute might be enacted by that body 
therefore, with less likelihood of attack than if enacted by a State 
legislature or by a municipal council. 

The milk law enacted in 1895 made it the duty of the health offi- 
cer of the District of Columbia, under direction of the Commission- 
ers, to make and enforce regulations to secure proper water supply, 
drainage, ventilation, air space, floor space, and cleaning of all dairies 
and dairy farms within said District ; to secure the isolation of cattle 
suffering from any contagious disease, and to carry into effect the 
provisions of the act. These regulations were duly made, and under 
date of June 26, 1895, were approved by the Commissioners. 6 It was 
the belief of the health officer that these regulations should be spe- 
cific rather than general, and as originally drafted they were of the 
former character. The then attorney for the District, however, enter- 
tained a different opinion, and in deference to his more extended 
experience with respect to such matters the regulations were reduced 

a See page 808 for full text of law. 

b Report of the Health Officer, 1896, page 256. 



761 

to their now somewhat general form, whether wisely or unwisely may 
properly be questioned. They have been amended from time to time 
and in the form in which they now exist appear elsewhere in this 
report. So also do various extracts from the building and police 
regulations bearing directly upon the construction and management 
of dairies. 

The milk law of 1895 represented at the time of its enactment a 
departure from established precedent. It was a more or less experi- 
mental measure, and therefore it could not be expected that it would 
be found to meet perfectly all the requirements of the service when 
put into operation. Experience soon revealed defects, and efforts 
were promptly begun to correct them. As early as December 15, 
1896, bills were introduced into Congress for that purpose, and 
legislation to accomplish the desired end has been pending before 
that body almost continuously ever since. The result, however, has 
not been encouraging. Bills introduced on the recommendation of 
the health officer, and receiving the indorsement of the Commissioners 
and of the Medical Society of the District of Columbia, have been uni- 
formly opposed by milk interests. Unfortunately, it has been im- 
possible in the drafting of legislation to deal with the milk interests 
as with a unit. The men who are engaged in the production of milk 
and in some cases in its distribution, and those who are engaged solely 
in buying milk and delivering it to the consumer, are too numerous 
and too widely scattered, and their interests are too diverse, to have 
enabled them to come together in a compact organization which might 
be reached as a whole, through its meetings or through any trade or 
society journal. It has been impossible for the health officer to sub- 
mit to the Commissioners or for the Commissioners to submit to 
Congress any bill to regulate the sale of milk in the District with the 
assurance that it would not meet with more or less formidable op- 
position from persons interested in the production and sale of milk, 
either individually or as an organization. The fight to obtain better 
legislation to regulate the sale of milk has always been carried to the 
committee room, at the Capitol, and the fight has always been lost. 

While it has been impossible to obtain needed amendments to the 
act of March 2, 1895, regulating the sale of milk, other legislation has 
been enacted that has modified the practice of the health department 
with respect to the supervision of the milk supply and the mainte- 
nance of the milk-inspection service. By the act of February 17, 1898, 
entitled "An act relating to the adulteration of foods and drugs in the 
District of Columbia," 6 the required chemical composition of milk 
was altered so as to raise the minimum allowable amount of butter 

a See page 819. 

6 See page 810 for full text of this act. 



762 

fat and of total solids in whole milk from 3 per cent and 12 per cent, 
respectively, as fixed by the milk law of March 2, 1895, to 3J per cent 
and 12^ per cent, respectively. By the same act a standard for the 
chemical composition of cream was* fixed, requiring a minimum of 20 
per cent butter fat, and this act changed generally the method of pro- 
curing samples. By the act making appropriations for the expenses 
of the District of Columbia, approved April 27, 1904, the following pro- 
visos bearing upon the enforcement of the laws and regulations relat- 
ing to the sale of milk were enacted, and they were repeated in each of 
the District appropriation bills passed until that of May 26, 1908 : 

Provided, That no officer or employee of the health department shall, during 
his continuance in office, serve in his private capacity for fee, gift, or reward 
any person licensed to keep or maintain a dairy or dairy farm in said District, 
or to bring or to send milk into the said District, or any person who has applied 
or is about to apply for such license, or -any manufacturer or dealer in foods, 
drugs, or disinfectants, or similar materials : Provided, further, That every 
place where milk is sold shall be deemed a dairy under the law for purposes of 
inspection. 

The first of these provisos was inserted in the then pending appro- 
priation bill in connection with a proposed increase in the salaries 
of the employees in the service of the health department whom the 
proviso was most likely to affect — that is, the inspectors of dairy 
farms. The increase in salaries was not made, but the proviso was 
allowed to remain. The effect was to deprive the inspectors of dairy 
farms of certain of the opportunities that they had previously had 
to add to the scant incomes that their official positions provided. Of 
these opportunities they had theretofore been allowed to avail them- 
selves from time to time as demands were made for their professional 
services, and they had done so without criticism or complaint. The 
principle laid down in this proviso is, however, recognized as emi- 
nently wise and proper, and yet it would seem that the fact should 
be recognized that its enactment into law reduced the possible in- 
comes from private sources of the employees who come within its 
scope, and that due compensation should be made because of that 
fact. The second proviso has unfortunately failed entirely to accom- 
plish the purpose for which presumably it was enacted — that is, to 
require every vendor of milk to provide himself with facilities for 
storing and distributing it similar to those required of proprietors 
of licensed dairies under like circumstances. The failure of the pro- 
viso has been due to the insertion of the words, " for purposes of 
inspection," the effect of which has been to limit the purpose for 
which places can be regarded as dairies, in which places milk is sold 
merely as an incident to some other business, to but one single thing, 
inspection. Neither for purpose of licensing or construction or man- 
agement do the dairy regulations apply. 

«33 Stats., 383. 



763 

The most recent legislation by Congress relating to the sale of 
milk in the District was enacted on February 27, 1907, under the 
title "An act to amend section eight hundred and seventy-eight of 
the Code of Law for the District of Columbia." The purpose 
of the amendment was to extend to dairymen the right, enjoyed by 
dealers in other beverages, to register with the clerk of the supreme 
court of the District of Columbia distinctive marks for the identifi- 
cation of the vessels in which deliveries are made, and thus to secure 
exclusive right to the use of such vessels, under pain of fine or im- 
prisonment imposed on any person trespassing against such rights 
The general statute commonly known as the pure food and drugs 
act, c June 30, 1906, by its terms covers much of the field covered by 
the District milk act of March 2, 1895, and the District pure-food 
act of February 17, 1898 ; so much so, in fact, that in a prosecution 
under the act last named, based upon the sale of adulterated milk, 
its validity was attacked on the ground that it had been repealed by 
implication through the enactment of the federal pure food and 
drugs act. The police court decided that the local statute had been 
so repealed and acquitted the defendant, but upon appeal by the 
District d the case was disposed of without the court finding it neces- 
sary to decide whether the earlier act had or had not been repealed. 
The court" of appeals, however, referring to the question of repeal, 
said: 

The question as to the entire repeal of the earlier act, the operation of which 
was confined to the District of Columbia by the later general law, is one of great 
importance that ought to be authoritatively settled. It is unfortunate, there- 
fore, that the police court did not content itself with quashing the information 
and dismissing the prosecution, in accordance with its view of the law, without 
going further and adjudging the defendant not guilty. While it seems probable 
that the court took an erroneous view of the law, we are without jurisdiction 
to express an opinion upon the question, by reason of the judgment actually 
rendered. 

Since the rendering of the decision from which the foregoing 
quotation is taken, the health department has prosecuted vendors of 
adulterated milk and cream under either statute, according as prose- 
cution under the one or the other was most convenient or seemed 
likely to yield the better results, and the question as to whether there 
has or has not been a repeal of the District pure- food law of February 
17, 1898, has not been settled. 

The results of the extensive investigations recently made by the 
Federal Department of Agriculture into the condition of the dairy 
farms and dairies supplying milk to the District, and of the milk 

a 34 Stats., 1006. 

6 See page 818 for full text of this law. 

c 34 Stats., 768. 

d D. C. v. Burns, 32 Appeals, D. C, 203. 



764 

sold here, have not yet been officially published. The results of the 
work done by the Public Health and Marine-Hospital Service during 
the summer of 1906, in connection with its investigation into the cause 
of the undue prevalence of typhoid fever, appear at length in one of 
the recent bulletins published by that service. All that is of general 
interest of the report of the conference called by the Commissioners 
of the District on March 30, 1907, to determine what should be done 
to improve the milk supply has been printed in certain circulars 
lately issued by the Department of Agriculture. 6 As valuable as this 
work has been, yet, in view of what has already been published con- 
cerning it and in view of the probable issue of further bulletins relat- 
ing thereto,. all of which are or will be available to those interested in 
the subject, it does not seem expedient to give any detailed account 
of it here. 

It could not be expected that with any reasonably rigid enforce- 
ment of the laws and regulations relating to the production and sale 
of milk, and the manufacture and sale of foods generally, over any 
considerable period, questions of construction would not arise and be 
submitted to the courts for adjudication. The first case that seems to 
be at all material to the purposes of this report is District of Colum- 
bia v. Lynham, c decided February 7, 1900. The case arose under the 
provisions of an act relating to the adulteration of foods and drugs 
in the District of Columbia, approved February 17, 1898,^ and the 
particular question submitted for decision was whether the defendant, 
a druggist, charged with the sale of a drug adulterated within the 
meaning of the act, was entitled to acquittal upon showing that he 
was at the time of sale ignorant of the composition of the substance 
sold. The court says : 

In the trial of a prosecution under this statute it is incumbent upon the Dis- 
trict of Columbia, in whose name the prosecution is conducted, to prove the sale 
and delivery of the medicine or drug by the defendant, or his possession thereof 
for purpose of sale, and that the same was adulterated within the meaning of 
the statute. The prosecution upon such proof makes out a prima facie case of 
guilt against the defendant; and it is no defense for the defendant to show 
simply that he was at the time of sale, or of possession for sale, ignorant of the 
fact of such adulteration of the drug or medicine. He must know what he sells, 
or proposes to sell, and that it conforms to the standard prescribed by law. As 
a registered druggist, he holds himself out to the public as being sufficiently 
skilled to know and understand of what constituents or ingredients the drugs 
and medicines that he offers for sale are composed, and especially in respect to 
all such drugs and medicines as are recognized and described in the Pharma- 

a Public Health and Marine-Hospital Service, Hygienic Laboratory. Bulletin 
No. 35. February, 1907. 

6 Bureau of Animal Industry, Circular 111, issued June 22, 1907. Circular 114, 
issued August 20, 1907. 

c 16 Appeals, D. C, 185. 

d 30 Stats., 246. 



765 

copoeia. It is not in his mouth to say, when it is shown that the drug was 
impure or adulterated at the time of sale, that he was ignorant of the fact. If 
such defense could be allowed, there would be no protection to the public against 
impurities and adulterations of drugs and foods. 

The second case to be decided, Weigand v. District of Columbia, 
decided November 5, 1903, involved, among other things, the applica- 
tion of the principle enunciated in District of Columbia v. Lynham 
(supra). It involved also the construction of "An act to regulate the 
sale of milk in the District of Columbia, and for other purposes," 
approved March 2, 1895, & and of "An act relating to the adulteration 
of foods and drugs in the District of Columbia," approved February 
17, 1898.°' Weigand had been convicted in the police court of selling 
adulterated milk, to wit, milk' containing less than 3^ per cent of 
butter fat. He had sought to show by evidence, and to have the jury 
instructed, that the provision of the act of Congress of 1898, pre- 
scribing the standard of milk for sale in the District of Columbia, 
was unreasonable and oppressive, and therefore void. But the court 
said: 

To declare an act of Congress unreasonable and oppressive, and therefore 
void, is a power that the courts can not exercise, except where the provision 
of the statute is shown to be plainly violative of some provision of the Consti- 
tution. The subject-matter of the act of 1898 is plainly within the power of 
Congress, and the courts can not amend or modify any of the provisions of that 
act so as to bring them within what may seem to be reasonable bounds. They 
can not examine questions as expedient or inexpedient, as politic or impolitic. 
Considerations of that nature must, in general, be addressed to the legislature. 
Questions of policy determined there are conclusive with the courts. (License 
cases, 5 Wall., 462, 475.) If, by the plain words of an act of Congress, an im- 
possible thing was required to be done, or some thing done in an impossible 
manner (if such legislation could be rationally supposed to occur), in such case 
the courts would have no alternative but to declare the statute to be incapable 
of enforcement in the particular case. But statutes are not to be declared void 
because of difficulty of construction, or because of apparent hardship in their 
application ; nor are the plain words of a statute to be refused their application 
upon any theory that a more reasonable provision could have been adopted for 
the state of case presented. All statutes must receive a sensible construction, 
such as will effectuate the legislative intention, and, if possible, so as to avoid 
an unjust or an absurd conclusion. (Law Ow Bow v. United States, 144 U. S., 
47, 59; Hawaii v. Mankichi, 190 U. S., 213.) It is true a municipal ordinance 
professed to be passed under a general or implied power given by a statute must 
be reasonable and lawful, and not oppressive, and if it be not so it will be 
declared void. But this is upon the presumption that the legislature did not 
intend by the general terms of the statute to authorize the making of such an 
ordinance. (1 Dill., Mun. Corp., sec. 319; Cooley, Const. Lim., 192, 193, 6th ed.) 
And it has therefore been held that an ordinance can not be held to be unreason- 
able and void which is expressly authorized by the legislature. (Coal Float v. 
The City of Jefferson, 112 Ind., 15; Cooley, Const. Lim., 241.) 

a 22 Appeals, D. C, 559. 
& 28 Stats., 709. 
c 30 Stats., 246. 



766 

In this case the offer was made to show, and the court was requested to 
declare, not that the act of Congress required milk to conform to an impossible 
standard or test, or that the milk offered for sale should contain constituents 
that nature did not supply, but that the standard prescribed was unreasonably 
high, and could not by ordinary care be maintained through all seasons of the 
year. There may be difficulty in keeping up the standard throughout the year, 
and more expense and greater effort may be required at some seasons of the 
year than at others. But the very object of the statute was to require this 
more than ordinary expense and labor, on the part of the owner of cows, to 
keep up and maintain the prescribed standard of milk when necessary ; and this 
is accomplished by proper care of and food supplied to the animals producing 
the milk. For it is well known that the quality and richness of milk depend 
largely upon the condition of the animal, the care with which it is kept, and 
the kind and quantity of food supplied to it. It is not attempted to be shown 
that 3i per cent of fat, as a constituent of good milk, is greater than can be sup- 
plied by proper care of, and good and abundant food supplied to, the cows. 
If the proposition of the defendant were sustained, the question of the reason- 
ableness of the statute would be one of fact for the jury, and we should likely 
have different juries determining the question in different ways. We think the 
court was clearly right in its ruling upon this question, and in holding that 
the question, whether the standard of milk prescribed by the statute was reason- 
able or not, was not open to inquiry on the trial. 

In the police court Weigand had been denied, too, the right to show 
by evidence the specific purpose for which he had in his possession 
the milk from which the sample was taken, but the appellate court 
found no error in the exclusion of such evidence, saying : 

But under section 3 of the act of 1898 the question is whether the sale was 
made of the article, which was in fact under the standard prescribed by the 
law. The party making the sale is bound at his peril to know what he is sell- 
ing, and, to keep within the law, he must know that the article complies with 
the standard of excellence and purity prescribed by the law. Unless this be so, 
it would be very difficult, if not impossible, ever to convict a party of a viola- 
tion of the law. And for the same reason the court below was right in refusing 
to allow the defendant to introduce evidence to show for what purpose he had 
kept the milk on hand — that being entirely immaterial, if he sold the milk that 
did not bear the test prescribed. 

The other questions decided by Weigand v. District of Columbia 
are not material for present purposes. 

The third case, District of Columbia v. Garrison,^ decided May 23, 
1905, arose under the provisions of "An act relating to the adultera- 
tion of foods and drugs in the District of Columbia," approved Feb- 
ruary 17, 1898, & and required the determination of the extent of the 
right of the inspectors in the service of the health department to 
purchase samples of food for analysis, under section 6 of the act, 
which is as follows: 

That every person offering for sale or delivering to any purchaser any drug 
or article of food included in the provisions of this act shall furnish to any 
analyst or other officer or agent of the health department, who shall apply to 

' a 25 Appeals, D. C, 563. 
6 30 Stats., 246. 



767 

him for the purpose and shall tender him the value of the same, a sample suffi- 
cient for the purpose of analysis of any such drug or article of food which is 
in his possession. 

The defendant had declined to sell to an inspector one-half pint 
of milk upon the tender of the usual price therefor, 2 cents, but had 
offered to sell one entire pint for 4 cents, alleging that he sold milk 
only in the original packages in which he received it, that he had no 
package containing less than 1 pint, and that if he sold a half-pint 
from such a package the remaining half pint would represent a loss 
to him, since his customers knew 7 that he did not sell milk in quan- 
tities less than a pint, and that therefore he had no demand for half 
pints. The police court having sustained the position taken by the 
defendant, an appeal w T as taken on the recommendation of the health 
officer. It w T as apparent that if one dealer were permitted to refuse, 
on the grounds taken by the defendant in this case, to sell less than 
a pint, another might fairly claim the right to refuse, on the same 
grounds, to sell less than a quart, and so on; that if inspectors were 
required to accept and to bring to the laboratory samples as large as 
1 quart, or even as large as 1 pint, their return trips to the labora- 
tory from the field must be correspondingly more frequent and their 
working capacity correspondingly diminished, and that if, on the 
other hand, the inspector undertook to mix the pint of milk thoroughly 
in the pint jar in which it was delivered to him or to mix a quart of 
milk in a quart jar, and to abstract therefrom a sample for analysis, 
the fairness of the sample might readily be called into question in 
event of prosecution. Moreover, the act under which the prosecution 
w r as brought limited the size of the sample w T hich the inspector might 
demand to " a sample sufficient for the purpose of analysis;" and one- 
half pint of milk was sufficient, the inspector could not demand more, 
and it w T as not apparent why he should be required to accept more; 
and the court of appeals had already declared (Weigand v. D. C, 22 
Appeals, D. C., 559) that the subject-matter of the act of 1898, under 
w^hich act the right to purchase the sample had been claimed, was 
plainly within the power of Congress, and that the courts could not 
amend or modify any of the provisions of that act so as to bring 
them Avithin what might seem to be reasonable bounds; that they 
could not examine questions as expedient or inexpedient, as politic 
or impolitic. 

The court of appeals, however, after denying that any principle 
was involved in the case, and after a scathing criticism of the health 
department for the course it had pursued, said: 

A reasonable sample is what is required by the act of Congress. Under 
the circumstances of this case a pint was a reasonable sample, and a half pint 
was not such a reasonable sample. The appellee was fully within his right, 
and fully performed his duty in tendering the former; the inspector was 



768 

wholly at fault in demanding the latter and insisting upon it against the will 
of the appellee. 

What may or may not be a reasonable sample is a question for which per- 
haps no positive rule can be laid down applicable to all cases. This is not 
for the determination exclusively either of the inspector or the dealer. The act 
requires that it shall be " sufficient for the purpose of analysis," but it is not 
competent for the inspector to require, because he thinks a half pint of milk 
sufficient to enable him to make a satisfactory analysis of such milk, that 
therefore the dealer must sell him such half pint, when thereby the value 
of another half pint would be destroyed or lost to the dealer, and the dealer 
is willing to sell an entire pint at an additional cost of merely 2 cents to the 
inspector. 

II. ORGANIZATION AND DUTIES OF THE MILK-INSPECTION 

SERVICE. 

Nothing worthy of the name of a milk-inspection service can be 
said to have existed in the District of Columbia prior to the passage 
of the act of Congress of March 2, 1895, for the regulation of the sale 
of milk. Not even, in fact, was a milk-inspection service established 
by that act. The necessary authority was conferred, but no special 
inspectors or funds were provided through which to exercise that 
authority, and the health officer in the execution and enforcement 
of the law had to rely upon the inspectors already provided for 
the sanitary and food inspection service generally, and upon the 
allotment made by the Commissioners for the contingent expenses 
of the health department from the general appropriation for that 
purpose. The health department had no veterinary surgeon in its 
employ, and for such assistance as was needed in the way of inspec- 
tions requiring the education and training of a veterinarian had to 
rely upon the veterinary surgeon employed by the District govern- 
ment, at a salary of $400 per annum, for all departments of the Dis- 
trict government. The situation of the health department under the 
circumstances was most unfortunate; errors that were made in the 
early days of the service because of an insufficient and untrained 
inspection force have come up from time to time to embarrass the 
department, and have been corrected w 7 ith difficulty, if at all. 

The conditions found as the result of such early inspections as w T ere 
made showed in many cases entire ignorance of even the most rudi- 
mentary sanitary principles connected with the production and mar- 
keting of milk. The stables were small, poorly lighted, and poorly 
drained. Many of the producers of milk had no idea of the impor- 
tance of cooling it immediately after milking, and sometimes did not 
hesitate to store it in living rooms and kitchens. a The condition of 
the cattle can be best understood from the statement made by Doctor 
Schroeder, of the Bureau of Animal Industry, as the result of the 

° Report of the Health Officer, 1896, page 21. 



769 

examination of over S00 of our dairy cattle during 1893* and 189-1, 
that between 5 and 6 per cent had defective udders. Those who are 
sometimes inclined now to criticise existing conditions would be able 
to do so more intelligently and fairly were they familiar with the 
conditions found in the early days of the milk-inspection service. Xo 
good purpose would be served by here recounting at length the 
various steps taken for the improvement of the service that was 
established. It is sufficient to say that improvement generally has 
been possible only as appropriations have been made by Congress to 
bring them about, and that requests for such appropriations have not 
always met with favorable response. A statement showing the 
growth of the milk-inspection service is appended. & It is enough 
here to describe the milk-inspection service as it now exists. 

The law regulating the sale of milk in the District of Columbia 
prohibits the maintenance of a dairy or a dairy farm within the 
District without a permit from the health officer. It does not define 
what a dairy or a dairy farm is. In practice, the health depart- 
ment has held the term "dairy " to mean the business arising from 
milk products, or a store devoted to the sale of milk and its products, 
and has held the term " dairy farm " to mean any premises upon 
which milk is produced for sale. Any place where milk is sold is 
regarded by the law of the District as a dairy for purposes of inspec- 
tion, but not for other purposes. Permits issued under the provi- 
sions of the act of March 2, 1895, have been issued, therefore, in 
three distinct series: First, permits to maintain dairies within the 
District of Columbia : second, permits to maintain dairy farms 
within the District of Columbia ; third, permits to bring or to send 
milk into the District of Columbia. In order that the records of 
the health department might show the number and the location of 
places from which milk is distributed as distinguished from the 
number and location of places where milk is produced, persons main- 
taining dairy farms within the District of Columbia and distributing 
milk directly to consumers have been regarded as maintaining dairies 
as well as dairy farms and have been required to obtain a permit 
for each purpose. A similar practice has been established with 
respect to persons maintaining dairy farms in adjacent States and 
distributing the milk directly to consumers within the District; 
they have been required to take out permits not merely to bring or 
send milk into the District, but also to obtain permits to maintain 
dairies within the District. In the issue of permits to maintain 
dairies to persons already authorized to bring or to send milk into 

° Bureau of Animal Industry, Bulletin Xo. 7, published in 1894, page 87. 
6 See page 792. 
c See page 762. 

45276°— Bull. 56—12 19 



770 

the District they have not been required to maintain fixed places of 
business within the District, but their dairy farms have been re- 
garded as the points of distribution. Copies of the forms now in use 
for application and for permits are appended. a 

The inspection service is naturally divided into two branches: 
On the one hand the inspection of dairy farms and on the other 
the inspection of dairies. But whenever a permit is issued for the 
maintenance of a dairy on a licensed dairy farm, either within or 
without the District, then inspections of the dairy are intrusted 
solely to the inspector of dairy farms already having the premises 
under his ' supervision, and the inspector of dairies is not required 
to visit the premises. 

The inspection of dairy farms requires not only a knowledge of the 
conditions under which milk should be produced, but also a knowl- 
edge of cattle, their selection, their feeding, their general manage- 
ment, and their diseases. Such work is therefore best intrusted to 
veterinary surgeons, and inspectors of this class have always been 
required to have had a proper veterinary training before appoint- 
ment. The inspection of dairies, places from which milk is sold at 
retail, requires, however, only a good working knowledge of the 
sanitary principles underlying the handling of milk. For these 
purposes, therefore, and for the collection of samples of milk, men 
have been selected because of their general qualifications, and have 
not been required to have special training or experience with respect 
to the milk business. In certain cases, in making appointments of 
men to be assigned to the inspection of dairies, weight was allowed 
to the fact that the applicants had been engaged in the dairy busi- 
ness, but the result can not be said to have justified the anticipations 
of the department. 

The knowledge and experience of the inspectors of dairy farms and 
the inspectors of dairies must be supplemented by knowledge of the 
chemical composition of milk and of milk products, and of water, 
and by a practical acquaintance with the methods of analyzing these 
substances. A chemist is employed for that purpose. The knowledge 
of these inspectors ought to be supplemented by a knowledge of the 
bacteriology of milk and of milk products, and of water, and by 
ability to analyze them microscopically and bacteriologically, but 
appeals from the health officer for an appropriation for the establish- 
ment and maintenance of a bacteriological laboratory, with a compe- 
tent bacteriologist in charge of it, have not yet been favorably acted 
upon. For the proper supervision and control of the work of the 
inspection of dairy farms, and of dairies, and of the work of the 
chemist, records must be kept and a very considerable volume of cor- 

See page 793. 



771 

respondence handled, imposing upon the department a large amount 
of clerical work. The amount of correspondence arising in connec- 
tion with the milk-inspection service is very large, because so many 
of the persons producing milk for sale within the District and whose 
premises are under inspection reside at points more or less remote 
from the city. The milk-inspection service is organized, in order to 
meet the conditions described above, as follows: (a) Supervision; 
(b) inspection of dairy farms; (c) inspection of dairies; (d) inspec- 
tion of milk. 

SUPERVISION. 

The magnitude and importance of the milk-inspection service amply 
justifies the employment of a chief inspector, to devote his time 
exclusively to supervising the work. The work to be done, however, 
calls for special qualifications, and men possessing such qualifications 
can not be induced to enter the service of the Government and aban- 
don all else, especially with no assured tenure of office, unless they are 
reasonably well paid. And no provision has ever been made for so 
compensating any such officer. As a matter of expediency, therefore, 
the supervision of this service is divided. The chief inspector of the 
health department is responsible for the sanitary condition of places 
where milk is sold within the District and for the collection and 
analysis of samples of milk and cream. The supervision of the places 
where milk is produced, the dairy farms, whether within or without 
the District, and the keeping of the records pertaining to such places, 
is intrusted to a sanitary and food inspector detailed for that purpose. 

The inspector in charge of the contagious-disease service is re- 
quired, in investigating such cases of typhoid fever, scarlet fever, 
and diphtheria as come to his notice, to ascertain whether they have 
possibly had their origin in the milk supply, and on the slightest 
suspicion to cooperate with the chief inspector and the inspector in 
charge of the dairy-farm service in ascertaining the exact facts of 
the case, and, under direction of the health officer, in taking such 
remedial action, if any, as may be found advisable. 

The inspector in charge of the dairy-farm service is supposed to 
devote at least one day each week to the personal inspection of the 
dairy farms under his supervision, and the chief inspector or his 
assistant is expected to be in the field at least one day each week 
looking after the work of the general inspection service, which is 
under his immediate control and which includes the inspection of 
dairies. All papers relating to any given dairy or dairy farm, in- 
cluding the original report made by the dairy-farm inspectors and 
carbon copies of score cards and of notices served, and copies of 
letters received and letters sent, are filed in jackets in such manner 
with the papers relating to any one given dairy or dairy farm, and 



772 

are kept together so as to facilitate ready reference. These records 
are open to the public, and persons desirous of knowing the standing 
of any dairy or dairy farm are given every facility to examine them 
and are urged to do so. 

INSPECTION OF DAIRY FARMS. 

The total number of farms now licensed to produce milk in this 
jurisdiction or to send milk into it from the adjacent States, Mary- 
land and Virginia, is 864. Milk is being shipped into the District 
from 18 farms in Pennsylvania, 18 in New York, and 12 in New 
Jersey, without licenses, by virtue of the provision in the law which 
authorizes the shipment of milk immediately after the filing of 
an application and until that application has been acted upon 
by the health officer. The funds available for the inspection of dairy 
farms have not been sufficient to permit the systematic inspection 
of farms in New York and Pennsylvania, and therefore action by 
the health officer has been indefinitely suspended. The applica- 
tions that have been filed present, of course, prima facie cases of full 
compliance with the laws and regulations of the District, and licenses 
might be lawfully issued. Experience has demonstrated, however, 
that the evidence presented in an application is not always to be 
relied upon, and therefore, pending the making of provisions for the 
regular inspection of these places, the course just set forth has been 
adopted. 

The territory under actual inspection is divided into six districts 
and one inspector assigned to each. Prior to September 20, 1907, 
there were but five districts, only five inspectors being then available 
for the inspection of dairy farms. The result was that in one dis- 
trict a considerable number of farms could not be inspected during 
the entire year. 

In order that an inspector of dairy farms may discharge his duties, 
it is necessary that he be provided with means of transportation. 
For this purpose each inspector of dairy farms is allowed by the 
District government $365 per annum to enable him to maintain a 
horse and vehicle for his official use. When an inspector is required 
to visit dairy farms beyond a driving distance from his place of 
residence, he is allowed actual traveling expenses, payment being 
made monthly on itemized vouchers, duly sworn to by the inspector 
and approved by the health officer. 

Notwithstanding the use of a horse and vehicle and the making of 
allowances for traveling expenses, the amount of work done by an 
inspector of dairy farms is seriously curtailed by the distance which 
he has to travel between the places which he inspects. This is true 
particularly in the more remote portions of the country from which 
the milk supply is derived, since dairy farms in such regions are few 



773 

and far between. A certain part of the inspector's time, too, not 
infrequently goes for naught during the summer season, when, if the 
cattle are to be examined, he must wait for them to be brought up 
from the pasture. And at any time of the year a careful inspection of 
a dairy herd of any considerable size, including, as it must, an exami- 
nation of the udders and lungs, of itself consumes a considerable time. 
In the most thickly settled parts of an inspection district an inspector 
may make six or eight inspections in a day. In remote regions he 
may be able to make but two and possibly only one. The records of 
the department show that the average number of dairy farms visited 
daily by one inspector during the fiscal }^ear ended June 30, 1909, was 
2.7, the computation being based upon the work of the six inspectors 
then on duty and on the actual number of days worked by the entire 
force on the inspection of dairy farms, viz, 1,589. The average 
frequency with which each of the 864 dairy farms actually inspected 
was visited during the period named was 4.9. 

An inspector assigned to an outlying district is required to live 
within the territory under his supervision. Thus, one inspector 
resides at Leesburg, Va., another at Germantown, Md., and a third at 
Frederick, Md. The inspectors having supervision of the three dis- 
tricts adjacent to the city, and in fact extending within it, reside in 
Washington. The number of dairy farms now under the inspection 
of each of these inspectors is as follows : 

Washington district No. 1 141 

Washington district No. 2 117 

Washington district No. 3 125 

Leesburg district . 136 

Germantown district 182 

Frederick district 163 

The local inspectors of dairy farms ordinarily visit the health 
office each morning to file reports of the preceding day's work and to 
receive instructions as to their duties for the day. If, however, an 
inspector expects to go a long distance during the day, in order to 
visit an outlying farm, this customary visit may be omitted. The 
inspectors residing at Leesburg, Germantown, and Frederick, under 
ordinary circumstances, visit the health office but once each month, 
forwarding to the health officer by mail daily such reports as may be 
necessary, and receiving their instructions in like manner. In any 
event, each day, either after visiting the health office, if a visit be 
required, or without such a visit if none be necessary, the inspector 
proceeds to examine certain of the dairy farms lying within the ter- 
ritory assigned to him. In determining which of these farms to visit 
he is guided by instructions from the health officer, by outstanding 
notices which he has served, and by a general knowledge of the condi- 
tion of the farms within his district. It is just here that the services 



774 

of a bacteriologist are most needed in connection with milk-inspection 
work. The bacteriological examination of milk as it reaches the city 
would show the location of the farms sending in persistently milk 
containing relatively large numbers of bacteria as compared with the 
general milk supply. The occurrence of such high bacterial counts 
being a sure indication of faulty methods of milking or of handling 
milk, inspection could be directed against the offending farms, farms 
having good records being inspected with less frequency, if necessary, 
to permit this to be done effectively. 

Having arrived at the farm, the inspector investigates the condition 
of the premises and of the dairy apparatus and utensils used in con- 
nection therewith, and examines into the condition and health of the 
cattle. He must rely upon -his own powers of observation so far as is 
possible. When this is not possible he must learn what can be learned 
by inquiry. For instance: A knowledge of the prevailing method of 
milking and of the promptness and thoroughness of cooling milk 
is very essential in every case, but in view of the distances between 
dairy farms the inspector commonly can not visit on a single day, at 
milking time, more than one, and rarely more than two farms; he, 
therefore, can not always obtain information with respect to this 
matter by his own observation, but must depend upon the statements 
of the farmer and of the farmer's help with respect to it. The same 
is true to an even greater extent with respect to the possible presence 
on the dairy farm of communicable diseases, such as typhoid fever or 
scarlet fever. Never is the veterinary inspector able to report posi- 
tively, solely as the result of his own observation, the existence of any 
such disease on the premises ; he must rely on such information as he 
is able to obtain from the farmer and those about the place, and to 
pick up from others in the neighborhood. 

Should an inspector of dairy farms, as the result of his examina- 
tion of the premises and of the cattle, find conditions in violation of 
the regulations governing such matters, his course is governed to a 
considerable extent by the location of the farm, whether it be within 
or without the District of Columbia. If the farm be within the Dis- 
trict the only means available for the enforcement of compliance with 
law is prosecution in the police court ; the offense is committed within 
the District, and the proprietor of the farm who is responsible for 
such offense is within the reach of ordinary criminal process. On the 
other hand, if the farm is located outside of the District, the offense, 
in so far as relates to the condition of the premises and cattle, is com- 
mitted in another jurisdiction and not only is the offender beyond the 
reach of any ordinary criminal process issuing out of the courts of 
the District, but the condition of the farm, located as it is in another 
State, is not and can not be in violation of the laws of the District of 
Columbia so as to render the proprietor criminally liable. His of- 






775 

fense begins when he brings or sends milk into the District without a 
permit to do so ; but his permit, if he has one, is by law conditioned 
upon the management of his farm in accordance with the laws of the 
District in so far as those laws do not conflict with state laws; and, 
therefore, if his farm presents circumstances in violation of law, the 
conditions upon which his permit was issued have been violated by 
him, and his permit becomes voidable at the election of the health 
officer, even if it does not become actually void. When a dairy farm 
is located beyond the limits of the District, compliance with District 
laws and regulations is enforced, therefore, not by immediate crim- 
inal prosecution, but by the cancellation of the permit, if necessary, 
and then if the milk from the tabooed farm is brought into the Dis- 
trict, by criminal prosecution of those responsible for the importation 
of the milk — the farmer who sends it in, if he can be found in the 
jurisdiction, or the dealer who contracts with the farmer to have the 
law violated and cooperates with him in its violation, or both farmer 
and dealer. Unless, however, the violation of the regulations is ex- 
tremely grave, or unless similar offenses have been of repeated occur- 
rence, summary action is not taken, but the offender is given an op- 
portunity to correct conditions, or at least given an opportunity, if 
he be a nonresident, of showing cause why his permit should not be 
canceled. If he be a resident of the District, even after final action 
by the health officer, he has his day in court. What has been said 
with reference to the cancellation of permits has had reference to 
cancellation because of the existence of insanitary conditions. Per- 
mits may be suspended or revoked, whether the farm be within or 
without the District, if the milk supply therefrom is exposed to in- 
fection by certain contagious diseases, but this is a matter that will 
be considered later. a 

If, then, an inspector of dairy farms has found conditions that 
must be corrected, he serves a notice on the responsible person requir- 
ing him to correct them within a specified period, or if the conditions 
are particularly bad, he may, if the farm is within the District, rec- 
ommend immediate prosecution in the police court, or, if the farm is 
located outside of the District, he may serve at once a notice requir- 
ing the licensee to show cause on or before a given day, to the satis- 
faction of the health officer, why his permit should not be canceled. 5 
If the farm be one for which no license has been issued, but for 
which application is pending, then, if the circumstances warrant such 
action, the inspector may recommend the immediate rejection of the 
application. Any notice prepared by the inspector is written in 
duplicate by means of carbon paper, the original being left on the 
premises and the carbon copy being forwarded to the health officer so 
as to reach him on the day following the day of service. 

a See page 783. 

6 For forms of notice, see page 801. 



776 

Inspectors have uniformly endeavored to cooperate with the farmer 
as much as possible toward securing the improvement of his premises. 
As an incident to the inspection of dairy farms, and in order that 
the dairy farmer and the health officer might be advised as fully and 
intelligently as possible of the inspectors' findings, the health officer 
devised some time ago a a system of scoring dairy farms, a feature 
of dairy-farm inspection which has since been widely adopted. It 
was deemed desirable, whether a notice was served or not, to inform 
the farmer as accurately as possible, at each visit, of the judgment of 
the inspector with reference to his establishment. A certain number 
of points was, therefore, allowed for each general feature of the dairy 
farm and the inspector required to grade the establishment accord- 
ingly. The form for scoring shows the maximum number of points 
attainable and the number allowed by the inspector, and is printed 
so that by means of carbon paper a duplicate copy can be produced 
without additional labor. The original is left with the farmer for 
his information and guidance, and the carbon copy is forwarded to 
the health officer with the daily report of the inspector of dairy farms. 
With respect to the scoring of dairy farms, however, this may be 
fairly said : That no one can interpret the meaning of another's score 
card unless he knows the principle upon which the rating has been 
made. It is possible either to fix an absolutely ideal standard of 
perfection and to score every feature of the establishment on that 
basis or to fix a reasonable standard, having in view the state of the 
dairy industry, either generally or in the vicinity and at the time 
when the scoring is to be done. The former method will give low 
scores; the latter will give higher ones. It can not be said that 
either method is wrong, and possibly, having in view the future state 
of the dairy art that is so devoutly to be hoped for, the former method 
is preferable. It is essential now, however, only that when we under- 
take to determine the significance of the scores of dairy farms we 
know which method has been followed. In one place, apparently 
under the former method of scoring, 30 points out of a possible 100 
has been regarded as a fair passing mark. & Under the other method 
70 would be none too high. 

Recently the Department of Agriculture has applied the tuberculin 
test to a considerable number of the dairy herds supplying milk to 
this District. This test has been applied under an " agreement " 
between the Department and the farmer, the latter undertaking to 
comply with certain conditions in consideration of the application of 
the test free by employees of the Agricultural Department. This 
agreement has varied somewhat in its terms during the period the 
work has been in progress, but all forms have provided for the 

a Report of the Health Officer, 1904, page 27. 
6 Hoard's Dairyman, April 5, 1907, page 268. 



777 



slaughter of reacting animals under the supervision of federal in- 
spectors. The loss in such cases falls directly on the farmer, since 
there is no provision for compensation. A copy of the agreement 
now in use is appended. Since such work was begun, and up to and 
including June 30, 1909. 2.010 animals have been subjected to primary 
tests. Of these, 201 have reacted. Of those not reacting to the first 
test, 1,237 have been retested and 60 reacted. All cattle tested have 
been duly tagged, in accordance with the terms of the agreements 
that have been signed. 

The identification of tagged cattle is, of course, easy, and therefore 
animals that have been tuberculin tested are thereafter easily recog- 



Farm of* 
Location. 



Date. 



190 



Va., McJ., D, C. 



















f^~ 










y y^r^ 


v^ 



Breed 

Color 

Markings 



Age 



Cause of 
Condemnation. 



inspector. 



Fig. 66. — Bertillon identification applied to cattle. 



nized. There is, however, no provision of law that authorizes tag- 
ging, and not infrequently difficulty is experienced in identifying 
and following up cattle condemned by the inspectors of dairy farms 
merely on the basis of physical examination. Such a cow, if found 
later on the dairy farm on which it was originally condemned, could, 
in many cases, be identified without difficulty. But if she had been 
transferred to any other farm she was less likely to attract attention 
and even if she did identification was not always easy. To minimize 
the difficulty of identification, the health department applied to dairy 



a See page 79" 



778 

cattle the principle of the Bertillon system of identification. Each 
inspector is provided with forms giving in profile the figure of a cow, 
right and left sides, and containing a space for descriptive memo- 
randa. The forms are small, so as to be easily carried in the in- 
spector's pocket. On such a form the inspector notes the charac- 
teristic marks of the cow condemned, and the time and place of 
condemnation. The inspector subsequently carries this form with 
him for a reasonable time, so that if he finds anywhere a cow that 
seems to resemble a cow that he has condemned he can confirm or 
allay his suspicions. 

The law regulating the issue of permits to dairy farms outside of 
the District provides that they shall be issued whenever the health 
officer is satisfied that the milk from the farm that is about to be 
licensed will be brought into the District without danger to public 
health. Since it has been so clearly demonstrated that milk from any 
herd that has not been tuberculin tested is dangerous to public health, 
unless effectually pasteurized, the health officer has found it im- 
practicable to issue permits to bring or send milk into the District 
from such farms. But as' the law permits any applicant to bring or 
send milk into the District from the time he files application and 
until his application has been rejected, the health officer has, in those 
cases where the applicant has complied substantially with all require- 
ments of the District laws and regulations, suspended indefinitely 
action on the application pending the adoption of some general meas- 
ure looking toward the compulsory tuberculin testing of all cows sup- 
plying milk to the District of Columbia or, as an alternative, the com- 
pulsory pasteurization of milk from cows not so tested. 

Each inspector of dairy farms files with the health officer, weekly, a 
report of his operations for the preceding week. a In addition to this 
he keeps his own record of outstanding notices, and as soon as prac- 
ticable after the expiration of the time allowed for the correction of 
objectionable conditions he visits the premises to see whether the notice 
has or has not been complied with. If it has been, the inspector 
makes report accordingly. If it has not, he takes action to enforce 
compliance. He may immediately serve a notice requiring the licensee 
to show cause, satisfactory to the health officer, why his permit should 
not be canceled. Or he may recommend that a letter of that purport 
be written by the health officer. 6 Or, if the farm be located in the 
District, he may recommend immediate prosecution in the police court, 
and with the approval of the health officer he may institute such prose- 
cution. If a licensee has been notified to show cause why his permit 
should not be canceled, and has failed to do so, or has shown no 
sufficient cause, then the health officer cancels the permit and notifies 

° See form for report on page 802. 
6 For copy of form see page 801. 



779 

the licensee and his consignee or retailer, if he have one, that such 
action has been taken. If thereafter the milk from that farm is 
brought into the District, the person at whose instance it is brought 
is prosecuted in the police court. 

INSPECTION OF DAIRIES. 

Two inspectors are available for the inspection of dairies — that is, 
of places where milk is sold within the District of Columbia — and for 
the collection of samples of milk. The number of licensed dairies 
within the district, independent of those located on dairy farms, is 
62. The number of places where milk is sold as a mere incident to 
some other more general business, which places must be regarded as 
dairies only for purpose of inspection and not for purpose of licens- 
ing, is considerable, probably as many as 1,500. The exact number, 
however, is not known, as such places are registered only as grocery 
stores, lunch rooms, and so on, and not as milk shops. They begin 
the sale of milk at the pleasure of the proprietor, discontinue it when 
he is ready, and resume the business at will; and the health officer 
knows nothing of it. Many of the latter class of places, however, 
being grocery stores, come not only under the occasional observation 
of the inspector of dairies, but also under the more frequent observa- 
tion of the food inspectors assigned to the supervision of markets and 
green-grocery stores. In view of the considerable amount of time 
necessarily consumed in bringing samples of milk collected to the 
health office from the places of collection, and with a view to increas- 
ing the amount of attention paid to the sanitary condition of dairies, 
it has been deemed best to assign one inspector solely to the sanitary 
inspection of dairies, requiring him to collect no samples of milk, or 
to collect them as an incident to his other work. The other inspector 
is detailed primarily to the collection of samples of milk from dairies, 
lunch rooms, and grocery stores, and other places where milk is han- 
dled for sale, and from the railroad stations where milk is received, 
any inspections of dairies which he may make being merely incidental 
thereto. The average number of inspections to which each licensed 
dairy was subjected during the year ended June 30, 1909, was 20.7. 
The average number of inspections made daily by the inspector of 
dairies was 4.3. 

In the inspection of dairies, the inspector is guided primarily by 
the regulations for the government of dairies and dairy farms pro- 
mulgated under the authority of the act of March 2, 1895. He en- 
forces, however, any and all laws and regulations relating to the san- 
itary condition of the premises which he visits. Enforcement is or- 
dinarily effected through the service of a notice allowing a certain 

a See page 762. 



780 

amount of time for the correction of the objectionable conditions. 
A carbon copy of each notice is filed with the health officer, with the 
daily report of the inspector, on the day following the day of service, 
the original being left with the person to be notified. If the condi- 
tions which the inspector finds are so excessively bad as to warrant 
such action, he not only gives instructions for their immediate cor- 
rection, but, with the approval of the health officer, institutes crim- 
inal proceedings in the police court at once. In the ordinary cases, 
however, after the expiration of the time allowed by the notice which 
has been served, the inspector visits the premises and if the objection- 
able conditions have been corrected he so reports. Otherwise, unless 
there is reason for allowing further time, police court proceedings 
are then instituted. A scheme for the rating of dairies has recently 
been devised and is now in use. A copy of the inspector's score card 
relating to any given dairy is filed in a jacket reserved for that dairy, 
with all other papers relating to the establishment, another copy hav- 
ing been furnished the dairyman for his information and guidance. 

INSPECTION OF MILK. 

The inspector charged with the collection of samples of milk is ex- 
pected to bring into the department daily not less than 20 samples of 
milk. He collected during the year ended June 30, 1909, 3,760 sam- 
ples of milk and cream, an average of 12.4 samples for each work day, 
including half holidays as full days. These samples he obtained in 
the open market from dairies, grocery stores, lunch rooms, or other 
places where milk is sold, or from milk wagons, or at the railroad sta- 
tions where milk from the dairy farm first reaches the city. Milk is 
obtained by purchase whenever anyone is present to receive the 
money. Money for the purchase of samples is advanced by the 
inspector out of his own funds, and he is reimbursed each month for 
the amount. thus expended. Vouchers for such reimbursement must 
be sworn to by the collector and approved by the chemist or the 
inspector detailed to assist him, such approval being based upon the 
quantity of milk actually delivered at the laboratory as shown by the 
laboratory record. The voucher may call for reimbursement for less 
milk than has been delivered at the laboratory, since in some cases no 
payment can be made at the time of collection, but it can not call for 
more. 

While one-half pint of milk is sufficient for purposes of analysis, 
yet in view of a decision of the court of appeals (D. C. v. Garrison, 
22 Appeals, D. C, 563 ) & it is necessary for the collector to purchase 
a pint whenever the vendor claims to sell nothing less than pints, un- 

a For copies of forms used in the dairy-inspection service, see page 806. 
6 For a statement relative to this decision, see page 766. 



781 

less the inspector is able to show that he sells in smaller quantities. 
In view of the court's decision, moreover, the department has felt 
compelled to purchase quart samples whenever it has been alleged by 
the vendor that he sold only in unbroken packages and had nothing 
smaller than 1 quart on hand, the department not being prepared to 
prove a contrary practice. It might be good administration to re- 
quire the collector to undertake to mix a pint or a quart sample on the 
premises of the vendor and to take therefrom so much as might be 
required for analysis and to dispose of the remainder then and there. 
In view of the difficulty, however, of thoroughly agitating a pint of 
milk in a pint bottle, or a quart of milk in a quart bottle, and to avoid, 
in event of prosecution, attack on the ground of the alleged inaccu- 
racy or unfairness of the sample thus taken, it has been deemed best 
to require the inspector to bring whatever milk he collects to the 
health office, where the mixing is done in the laboratory. The neces- 
sity for carrying such a large amount of milk tends to diminish the 
working capacity of the inspector. Samples collected are labeled at 
the time of collection and a record kept by the collector. The samples 
collected are delivered to the chemist or to his assistant and are im- 
mediately analyzed. If the result of the analysis shows that the cir- 
cumstances warrant such action, prosecution is instituted by the 
analyst. The inspector who collected the samples testifies as to its. 
origin and the analyst testifies as to its composition. 

Arrangements were once made whereby the vendor could, when a 
sample was purchased, be supplied by the inspector with a portion 
of it, duly sealed, so that the vendor could have an analysis made 
independent of the official analysis, if he so desired. This, however, 
did not do away with the necessity for reserving in the health office a 
portion of any sample upon an analysis of which prosecution is to 
be based, since the reserving of such samples is required by statute. 

The results of all analyses are transcribed from the laboratory note- 
book to the official laboratory record, and thereafter are entered upon 
index cards so that the results of the analyses of all samples pro- 
cured from any one dealer can be seen by a glance at his laboratory^ 
card. On this card are subsequently entered memoranda showing 
the results of such prosecutions, if any, as are instituted. If the anal- 
ysis shows that the sample of milk purchased does not conform to the 
legal standard, the vendor is notified of that fact, and if it is the 
purpose of the department to institute a prosecution against him, a 
portion of the sample is reserved, duly sealed and kept under lock 
and key, so that the vendor may obtain it and submit it to an inde- 
pendent analysis if he so desires. All samples that are found to be 
of standard quality are delivered to one of the local charitable insti- 
tutions supported at public expense. It was formerly the custom of 
the department to inform the vendor of every sample of milk pur- 



782 

chased as to the result of the analysis, without reference to the quality 
of the milk analyzed, whether above or below standard. It was 
discovered, however, that in some cases, vendors of milk were ex- 
hibiting in their places of business official reports of the analysis of 
samples of high grade, while failing to display reports showing the 
collection of bad samples. As the practice was liable to mislead the 
public, the sending out of notices giving information as to the anal- 
ysis of samples at or above the legal standard was omitted. 

No analyses of samples of milk submitted by dealers are made, and 
only under exceptional circumstances are analyses made of samples 
of milk submitted by private citizens. It is the general practice of 
the department with respect to the latter class of samples to make 
analyses only when the person submitting the samples signifies his 
ability to testify that the sample submitted is in the same condition 
which it was when it was left at his residence, and his desire or will- 
ingness to prosecute the vendor if the sample be found to be of an 
unlawful character. Upon receipt, however, of complaint as to the 
quality of the milk delivered to any individual, whether a consumer 
or a dealer in milk, the department will, if other official business per- 
mits and the complaint seems to justify such action, collect a sample 
or samples from the suspected vendor through the department's own 
agents and make the necessary analyses. Examinations of this char- 
acter for dealers in milk are, however, restricted to the smallest pos- 
sible number, since if any other course were adopted the requests 
from dealers for such service would probably be so numerous as to 
interfere with the general work of the department. 

The practice of the department with respect to the analysis of sam- 
ples of milk for dealers works no hardship on the larger dealer, since 
for his own protection from a purely commercial standpoint he is or 
should be prepared to have all milk which he purchases analyzed in 
his own place of business. The smaller dealer can not well do this, 
and to him it would be of advantage if from time to time he could 
obtain analyses of the milk which he purchases, without cost or at a 
reasonable charge. It would be advisable, therefore, to increase the 
laboratory facilities of the health department, and to authorize the 
analysis of samples of milk and of other foods for reasonable fees, 
so that dealers in milk or of other articles of food or of drugs might 
be able better to supervise and control the articles which they handle. 
Fees from such a laboratory might be adjusted so as to make it self- 
sustaining and to permit the force of the laboratory to be increased, if 
necessary, in proportion as the work and, therefore, the fees increased. 
By this method the needs of the dealer could be met and the regular 
inspection work of the department need not be interfered with. 

In order to reduce to a minimum the time spent in the police 
court by the chemist and his assistant, and by the inspector detailed 



783 

for the collection of samples of milk, and in order to limit the amount 
of clerical work connected with the service, cases are not referred 
daily to the corporation counsel for prosecution, but only at the end 
of each week. The chemist after the close of the week prepares a 
report showing the work done in the chemical laboratory. He re- 
ports from time to time the names and addresses of all persons who 
have sold samples of milk or other foods, which ha ye been found to 
be of an unlawful character. On such reports the chemist recom- 
mends either that a prosecution be instituted or that it be not insti- 
tuted. The minimum amount of butter fat which milk must contain 
in order to permit its lawful sale as whole milk is 3.5 per cent. 
This standard is a reasonable one and should insure the sale of a 
high-grade article. At times, however, even the most careful dealer 
may allow his milk to fall below it. The practice of the department 
requires that wherever a sample of milk is found to contain added 
water or a preservative, or to be colored, or to contain less than 3.25 
per cent butter fat, prosecution is to be instituted as a matter of 
course. If the butter fat is 3.25 per cent or more, but less than 3.5 
per cent, then prosecution is or is not instituted according as the 
entire recent record of the vendor is good or bad. If his milk has 
been repeatedly below 3.5 per cent, then even though the present 
sample shows more than 3.25 per cent, prosecution is instituted. In 
cases within this class, where the element of judgment enters, the 
inspector submits with his report and recommendations a statement 
showing the recent record of each vendor. A similar practice is in 
force with respect to cream, the legal standard for butter fat being 
20 per cent, and prosecution being instituted as a matter of course 
if the amount contained in a given sample falls below 18 per cent, 
and being instituted or not, according to the entire recent record of 
the vendor, where the amount of butter fat is 18 per cent or more and 
yet less than 20 per cent. 

In the chemical laboratory are analyzed samples of water from 
wells on dairy farms. These samples are collected by inspectors of 
dairy farms, and if from near-by farms are brought to the chemist by 
the inspector. If from outlying farms, as. for instance, those in the 
Frederick district, samples are forwarded by express. 

CONTAGIOUS-DISEASE SERVICE. 

Attention has already been called to the difficulty which an in- 
spector of dairy farms incurs in any effort that he may make to 
detect on the farm cases of communicable diseases, such as typhoid, 
scarlet fever, or diphtheria. For the information of those of the 
readers of this report who are not familiar with technical matters 
relating to milk inspection, it is necessary to add that by no known 



784 

method of chemical or bacteriological analysis can the possibility, or 
even the probability, of the presence in milk of the typhoid bacillus 
or the diphtheria bacillus be excluded with any reasonable degree 
of certainty; that the colon bacillus is not an infrequent inhabit- 
ant of milk, its presence indicating merely contamination with the 
excrement of the cow and not even suggesting sewage pollution ; and 
that the organism that causes scarlet fever is as yet entirely un- 
known. Under such circumstances, the following method has been 
adopted to facilitate the detection of contagious diseases on the 
dairy farm: 

Upon receipt by the health department of a report of a case of 
typhoid fever, scarlet fever, or diphtheria, an inspector from the 
health department visits the premises where the patient is and ascer- 
tains the name of the dairyman who furnished the milk consumed by 
the patient prior to the onset of his illness. The dairyman is im- 
mediately notified to discontinue leaving milk bottles at the infected 
premises or apartment until after the recovery or removal of the 
patient, of which event he is notified at the time of its occurrence. 
Bottles containing milk, if left at infected places, may be taken into 
the sick room and possibly even directly used by the patient, and then, 
in view of imperfect methods of disinfection adopted by the attend- 
ants and of imperfect methods of cleaning adopted by the dairymen, 
may be the means of spreading disease. The name of the dairyman 
who supplies milk to the patient having been ascertained, and the 
dairyman having been notified to discontinue the delivery of bottles 
at the infected place, the case is entered on the records of the health 
department to the dairyman's account. This is done by the inspector 
in charge of the contagious-disease service personally, and if at any 
time it seems that the number of cases being charged to any one dairy- 
man is out of proportion to the size of his business, due regard being 
paid to the general extent to which the disease is prevailing in the 
District, then inquiry is immediately begun to ascertain whether his 
milk supply is or is not exposed to infection. Such investigations are 
made by medical officers in the contagious-disease service and by the 
veterinary surgeons in the milk-inspection service. The local estab- 
lishment of the milk dealer is visited and an effort made to ascertain 
whether he or anyone in his family, or any employee or his family, or 
anyone to whom they have been exposed, is suffering from the disease 
under consideration. A similar course is pursued with reference to 
the dairy farm. The water from the dairy farm is analyzed, if there 
is any indication for such procedure. If the circumstances show that 
the milk supply is exposed to infection, then immediate action is taken 
to remove the danger. Permits are suspended or revoked, with or 
without notice, if circumstances indicate that such action is called for, 
and are renewed or^reissued only after all danger is passed. In some 



785 

cases it has been found possible to remove the source of danger with- 
out putting the dairyman out of business, and whenever possible such 
measures, less radical so far as the dairyman is concerned, have been 
adopted. While the method outlined above for detecting and remov- 
ing danger from infected milk is not ideal, in that it does not reveal 
the presence or the location of the disease until a small or possibly a 
large number of persons have been infected, yet, so far as is known, it 
is the only practicable method that has yet been devised. The safety 
of the community with respect to the possible spread of communi- 
cable diseases of human beings through milk depends primarily on 
clean intelligent dairying, and for this there is no substitute. 

COST OF MILK INSPECTION. 

It is not difficult to state exactly the amount appropriated specific- 
ally for the milk-inspection service, but it is impossible to do more 
than to approximate its actual cost. Some of the time of the health 
officer and of certain other officers and employees in the employ of 
the health department is given up in part to the service named, and a 
part of the contingent expenses of the service are so closely bound up 
with the general contingent expenses that accurate separation is im- 
possible. The following statement shows, however, approximately 
the present cost of the service per annum : 

Annual cost of milk-inspection service. 

SPECIFIC APPROPRIATIONS. 

1 inspector, dairy farms $1, 200 

5 inspectors, dairy farms, at $1,000 5, 000 

1 inspector, dairies 900 

] inspector, collecting samples 900 

1 inspector, assisting chemist 900 

GENERAL APPROPRIATIONS. 

[Pro rata chargeable to milk-inspection service.] 

20 per cent salary of health officer $800 

20 per cent salary of assistant health officer 500 

Salary of supervising inspector 1,200 

10 per cent salary of chief inspector 180 

25 per cent salary of chemist 450 

Salary of inspector detailed to assist chemist 900 

5 per cent salary of inspector in charge of contagious-disease service 120 

20 per cent salary of clerical force of health department 1, 760 

2 per cent general contingent allotment to health department 70 

20 per cent allotment for postage 124 

40 per cent contingent fund for chemical laboratory 400 

75 per cent appropriation for traveling expenses 4, 500 

Total 19, 004 

45276°— Bull. 56—12 50 



786 

Statements showing the amount specifically appropriated for the 
milk-inspection service, and the work accomplished, are appended. a 

Time and space will not permit a discussion of the claim made by 
some that the efforts of the Government to bring about an improve- 
ment in the milk supply have resulted in an increase in the cost of 
milk to the consumer. The increase in the price of milk is in keeping 
with the increase in the price of almost everything else and is terri- 
torially too widely spread to have been brought about simply by the 
enactment or proposed enactment of laws for the improvement of the 
milk supply. As a matter of fact, too, very few producers of milk 
in this vicinity have any accurate idea of the actual cost of produc- 
tion or of the net increase in the cost, if any, brought about by the 
enforcement of existing dairy regulations. Not knowing the cost of 
production, the individual producer can not fix intelligently the 
lowest price at which milk must be sold in order to produce a fair 
profit, but is guided by general impressions only and by prevailing 
custom. He does undoubtedly know, however, that the cost of pro- 
duction has been increased by higher prices for foodstuffs and for 
labor; his monthly expenditures must show this. If he proposes to 
increase the price of milk merely in proportion to the increase in the 
cost of production and to the increase in the cost of the farmer's liv- 
ing, the public should not complain. But the increase should be fairly 
and frankly stated, and the necessity for it should not be used un- 
fairly as a club with which to beat down future legislation for the 
improvement of the milk supply. 

RESULTS. 

The results of the milk-inspection service must not be measured 
by bacterial counts or chemical analyses. These are mere incidents. 
The purpose of the service is to prevent sickness and to save human 
lives, and by its efficiency in accomplishing these ends it must be 
judged. In the first place, then, the milk-inspection service has 
assisted the health department in discovering outbreaks of typhoid 
fever and scarlet fever, due to milk infection. Of these outbreaks, 
seven were of typhoid fever and two of scarlet fever. & And the milk- 
inspection service alone has, after the discovery of such outbreaks, 
enabled the health department usually to locate the very focus of 
infection, and commonly to do so in time to take effective action to 
cut short the progress of the disease. 

While the relation between the milk supply and the spread of the 
diseases named above is important, it is less so than is the relation 
between the milk supply and infant mortality; the death rate of 
infants is the commonly accepted standard by which the efficiency of 

° See page 792. 

6 For details as to these outbreaks, see page 51 et seq, 



787 

the milk-inspection service of any community is measured. It may 
be claimed, however, and with some show of propriety, that many 
factors other than improvement in the milk supply have been at work 
to reduce the number of infantile deaths ; or that a diminishing birth 
rate may account for the lessening of the infantile death rate, com- 
puted as that death rate perforce is, upon the total population and 
not upon the basis of the infantile population alone. To eliminate 
as nearly as possible error from these causes, no effort has been made 
to gauge the results of milk inspection by the general infantile 
mortality, but consideration has been limited to one single class of 
diseases, the intimate relation between which and the milk supply 
is almost universally conceded; that is, to diarrhea and enteritis 
occurring among children under 2 years of age. 

When a sudden drop in the death rate from any particular cause 
is practically coincident with the inauguration of measures intended 
to bring about that very result, when there is no other discoverable 
cause for such drop, and when the lower death rate persists with the 
continuance of such measures and continues to fall in proportion, 
more or less, to their efficiency, it is reasonable to suppose that the 
relation of cause and effect exists. And such are the circumstances 
with respect to the improvement in the milk supply of the District 
of Columbia and the diminution in the mortality from diarrheal 
diseases among persons less than 2 years old. The beginning of a 
persistent fall in the general death rate appears when we compare 
the figures for 1892 with those for 1893. A fall in the death rate 
of infants under 1 year of age appears at the same time. But no 
permanent lowering appears in the death rate from diarrhea and 
enteritis among children under 2 years of age until the second year 
after the enactment of the milk law. This law was enacted March 2, 
1895, and a certain period elapsed before it could be put into effective 
operation. The death rate from diarrhea and enteritis among infants 
during the fiscal year following its enactment was 168 per 100,000. 
The next year it had fallen to 151, the third year to 136, and the 
fourth year to 110. There have, of course, been slight fluctuations. 
In the calendar year 1900 the death rate rose to 132 per 100,000, but 
the annual average for the five-year period, 1900-1904, was only 109, 
and during 1903 it fell to 91. In 1905 the rate was 104, and in 1906 
it was 97. In 1907 it was 98, and during 1908 it remained at the 
same figure. The death rate from diarrhea and enteritis among chil- 
dren under 2 years old during the five-year period preceding the 
enactment of the milk law, in 1895, was 175 per 100,000. If the 
same rate had continued during the thirteen years that elapsed after 
its enactment and prior to December 31, 1908, the number of deaths 
from these causes would have been approximately 6,949, or 2,386 
more than actually occurred. And if the number of fatal cases of 



788 

diarrhea and enteritis, whether averted through the operation of 
the milk law or otherwise, was 2,386, how much more numerous must 









































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have been the cases in which infants were spared attacks of a milder 
character ? 



789 

Possibly some of the apparent saving of the lives of 184 infants 
yearly, and the apparent prevention of sickness, may have been due 
to a diminishing birth rate, but the records of the health depart- 
ment show no reason for believing that it was all due to that cause. 
Some of it may have been due to the improvement in the general 
sanitary condition of the city ; some to a better understanding on the 
parts of parents as to how to care for their children; and some to 
increasing ability on the part of the medical profession to treat such 
diseases. These factors, however, had been operating for a long 
period before the enactment of the milk law, but without apparent 
effect. The death rate from diarrheal diseases of infants during the 
five-year period, 1880 to 1884, was 162 per 100,000 ; during the next 
period it was 168, and from 1890 to 1894 it was 175. Is there any 
reason to believe that in 1895, the very year the milk law was enacted, 
some circumstance, as yet undiscovered, rendered potent these there- 
tofore inert factors, so that in the period from 1895 to 1899 they made 
the death rate from infantile diarrhea and infantile enteritis fall to 
135, during the next period fall to 109, during the j^ear 1905 fall to 
104, during the year 1906 to 97, and during 1908 and 1909 to 98? 
Or was it not the enactment of the milk law in 1895 and the continu- 
ous and increasingly efficient enforcement of it that has wrought this 
result? The facts are here stated, and pending a further study of 
the matter the reader must be left to draw his own conclusions. This, 
however, can be said without fear of successful contradiction, that if 
.the enactment of the milk law of 1895 has prevented only one iota 
of the deaths and the sickness that it seems to have prevented, the 
milk-inspection service has amply justified its existence. 

SUPPLEMENTARY MEMORANDUM— GOVERNMENT OF THE DIS- 
TRICT OF COLUMBIA. 

In order that readers of this report who do not reside in the Dis- 
trict of Columbia may better comprehend the situation that exists 
there with respect to the supervision of the milk supply, the follow- 
ing statement is made. Those who are residents of the District of 
Columbia, or most of them, are probably already familiar with every- 
thing that it contains. 

The District of Columbia covers only 60 square miles of land, 
lying on the Potomac River between the States of Maryland and 
Virginia. According to the federal census of 1900 it had a popula- 
tion of 278,718. The police census of 1906 showed, however, a popu- 
lation of 326,435, which is manifestly larger as compared with the 
federal returns, but is in harmony with police censuses of other 
recent years. Approximately 30 per cent of the population is colored. 
In view of its large population and relatively small area, the greater 
part of the District is urban in character, and most of the milk sup- 



790 

ply is produced in neighboring States. There is in law no delimita- 
tion between the present city of Washington and the District of 
Columbia. 

The District of Columbia is not self-governing, but is under the 
control of the Government of the United States. All legislation of 
any considerable importance is enacted by the Federal Congress, and 
all appropriations whatsoever are made by it. For the latter purpose 
all local revenues are paid into the Federal Treasury. As a very 
general rule, any appropriation that is made comes one-half from 
the revenues of the District of Columbia and one-half from the reve- 
nues of the United States, but appropriations have occasionally been 
made wholly from local revenues. 

For purposes of administration, the immediate direction of the 
affairs of the District is intrusted to a Board of Commissioners, two 
of whom are appointed by the President from among the residents 
of the District of Columbia, and confirmed by the Senate, the third 
Commissioner being detailed from the Engineer Corps of the Army. 
The general duties of the Board of Commissioners are executive, but 
the Board now has a considerable legislative power relating to mat- 
ters not deemed of such vital importance as to be reserved for the 
exclusive jurisdiction of Congress. 

Laws and regulations relating to public health are executed and 
enforced by a health officer, appointed by the Commissioners and 
responsible to them. There has been no board of health in the Dis- 
trict of Columbia since 1878, when the present form of government 
was established. Prior to that date, and as far back as 1871, there 
had been a board of health created by act of Congress having juris- 
diction over the entire District of Columbia, and before that the city 
of Washington and the city of Georgetown, each then a separate 
municipal corporation, had their own boards. 



791 



Exhibit A. 



-Showing certain death rates in the District of Columbia before and 
after the enactment of the milk law of March 2, 1895. 





Death rates per 1,000 of entire population, a 


Year. 


General 
death rate. 


Of persons 

1 year and 

over. 


Of persons 

under 1 

year. 


From diar- 
rhea and 
enteritis 
under 2 
years. 


Fiscal year: 

1880 


23.88 
24.60 
22.33 
23.74 
24.64 


16.93 
18.06 
16.47 
17.83 
18.28 


6.95 
6.54 
5.86 
5.91 
6.36 


2.09 


1881 


1.14 


1882 


2.21 


1883 


1.55 


1884 


1.16 






Average 5 years 


23.85 


17.54 


6.31 


1.62 






1885 


24.77 
22.97 
22.30 
24.23 
23.15 


18.64 
17.03 
16.14 
17.31 

17.28 


6.13 
5.94 
6.16 
6.92 
5.87 


1.79 


1886 


1.44 


1887 


1.65 


1888 


1.58 


1889 


1.49 






Average 5 years 


23.48 


17.27 


6.21 


1.68 






1890 


23.81 
25.16 
25.36 
23.25 
21.89 


17.43 
19.04 
18.58 
16.96 
16.19 


6.38 
6.12 
6.78 
6.29 
5.70 


1.85 


1891 


1.46 


1892 


1.69 


1893 


1.88 


1894 


1.89 






Average 5 years 


23.95 


17.70 


6.25 


1.75 






1895 b 


21.23 
21.16 
19.75 
20.54 
20.32 


16.00 
15.84 
15.05 
16.13 
15.93 


5.23 
5.32 
4.70 
4.41 
4.39 


1.10 


1896 


1.68 


1897 


1.51 


1898 


1.36 


1899 


1.10 






Average 5 years 


20.59 


15.77 


4.82 


1.35 






Calendar year: 

1900 


20.61 
20.19 
18.95 
19.08 
19.61 


16.04 
16.07 
14.91 
15.57 
16.05 


4.57 
4.12 
4.04 
3.51 
3.56 


1.32 


1901. .• : 


1.15 


1902 


1.08 


1903 


.91 


1904 


1.02 








19.68 


15.73 


3.95 


1.09 






1905 : 


19.20 
19.35 
19.25 
18.08 


15.68 
15.57 
15. 85 
14.84 


3.52 

3.78 
3.40 
3.24 


1.04 


1906 


.97 


1907 




1908 


.98 







° Reasonably accurate data are not available for the calculation of these infantile death 
rates upon the basis of the infantile population alone. 

6 The act now regulating the sale of milk in the District was approved March 2, 1895. 



792 

Exhibit B. — Cost and work of the milk-inspection service of the District of 

Columbia. 

[Appropriations made for the supervision and control of the milk supply of the District of 

Columbia.] 





Number of employees of each grade. 


Traveling 
expenses, 
outside 
District of 
Columbia. 


Contingent 
expenses, 
chemical 
labora- 
tory. 


Date of ap- 


Fiscal year. 


$400. 


$900. 


$1,000. 


$1,200. 


$1,500. 


$1,600. 


$1,800. 


propriation 
act. 


1895-6 


a\ 






61 

ocl 
acl 
a c\ 
el 
el 
el 
el 
cl 

el 

el 
el 
c,l 

el 










$250 


Mar. 2, 1895 


1896-7 






61 
61 
61 
61 








June 11,1896 
Mar. 3, 1897 
June 30 1898 


1897-8 
















1898-9 
















1899-1900 
















Mar. 3, 1899 


1900-1 




1 
5 

7 

7 

3 

3 
3 
3 
3 


4 

4 
4 
5 
5 


61 
61 








June 6, 1900 
Mar. 1, 1901 


1901-2 










1902-3 




61 
61 

61 

61 
61 
61 
61 


$1,000 
1,200 
J 1,200 
{ 300 
1,200 
1,500 
2,000 
3,000 


d 1, 000 


Mar. 3, 1903 


1903-4 








July 1, 1902 
Apr. 27,1904 


1904-5 








\ d 1, 000J 

d 1, 000 
d 1, 000 
d 1, 000 
d 1, 000 


1905-6 








eMar. 3, 1905 
Do. 


1906-7 








June 27,1906 


1907-8 








Mar. 2, 1907 
May 26,1908 


1908-9 

















a Veterinarian to all branches of the District government. 

b Chemist ; performs all chemical work for the health department and much for other 
branches of District government. 

c Inspector of live-stock and dairy farms. 

d This fund covers all expenses of chemical laboratory, whether related to milk or not. 

e Deficiency. 

[The records of the inspection of dairies has not been kept in such a manner as to permit 
the making of a statement showing the relative amount of work done from year to 
year.] 



Year. 


Number 
of dairy 
farms in- 
spected. 


Number 
of inspec- 
tions of 
dairy 
farms. 


Number 

of cattle 

on dairy 

farms. 


Number 
of inspec- 
tions of 
cattle. 


Number 

of 
samples 
of milk 

analyzed. 


Number 

of 
samples 
of cream 
analyzed 


1894-5 










545 

479 

244 

350 

273' 

413 

776 

4,737 

6,090 

7,798 

7,803 

6,066 

4,511 

4,652 

3,659 


21 


1895-6 












1867-7 




405 
(a) 

596 
806 
957 
2,265 
3,399 
4,092 
3,633 
3,526 
3,932 
4,407 
4,294 






6 


1897-8 








7 


1898-9 






3,240 
3,508 
15, 459 
38, 645 
64,879 
69, 108 
61,708 
59,851 
65, 600 
73,142 
70,231 


53 


1899-1900 






39 


1900-1 


841 

788 
867 
930 
918 
883 
904 
902 




59 


1901-2. 




334 


1902-3. 


15, 930 

17,733 
16, 166 
16,250 
15, 950 
16, 172 
16, 116 


146 


1903-4 


150 


1904-5 


427 


1905-6 


651 


1906-7 


449 


1907-8 


381 


1908-9 


101 







° The record for the year 1898 fails to show the number of inspections of dairy farms 
actually made. 

b The record for the year 1902 fails to show the number of farms actually inspected. 



793 

Exhibit C. — Selected forms used in the milk-inspection service of the District of 

Columbia. 

APPLICATION FOR PERMISSION TO BRING OR SEND MILK INTO THE DISTRICT 

OF COLUMBIA. 

INSTRUCTIONS TO APPLICANTS. 

1. The act to regulate the sale of milk in the District of Columbia provides 
that no person shall bring or send into the District of Columbia for sale any 
milk without a permit so to do from the health officer of said District, and that 
such permits shall be issued subject to the following conditions : 

That none but pure and unadulterated milk shall be, with knowledge of its 
impurity, brought into said District. 

That in the management of the dairy farm upon which the milk is produced, 
or of the dairy at which the milk is collected and stored prior to shipment, 
the applicant shall be governed by the regulations of the health office of the 
District of Columbia, approved by the Commissioners of said District, issued 
for dairies and dairy farms in said District, when said regulations do not con- 
flict with the laws of the State in which said dairy or dairy farm is located. 

A copy of the regulations above referred to is herewith inclosed. 

The said dairy or dairy farm may be inspected at any time without notice 
by the health officer of the District of Columbia or his duly appointed repre- 
sentatives. 

2. This application should be made out in ink and signed with your full name. 
If applicant is a married woman she should sign her own name in full and 
insert her husband's name in the space provided for that purpose. 

3. To insure the freedom of your dairy herd from tuberculosis it is advised 
that it be tuberculin tested and suitable disposition made of reacting animals. 
In no other way can its freedom from tuberculosis be demonstrated. If you 
desire to have the tuberculin test applied sign the accompanying blank form 
of agreement for that purpose and return it to this department. It will then 
be transmitted to the Bureau of Animal industry, and your herd will be tested 
without cost to you. This test should by all means be made, thereby removing 
a source of infection to your well cattle and protecting the persons who con- 
sume your milk. 

4. Under the law no permit can be issued until after the health officer is satis- 
fied that the milk from the dairy farm to which the permit relates will be brought 
into the District of Columbia for sale and distribution without danger to public 
health. Immediately after the filing of the application, however, if it be in 
proper form, the applicant can lawfully bring or send milk into the District 
of Columbia and can continue to do so until after his application has been 
acted upon by the health officer. An inspection of your premises will be made 
as soon as practicable after the filing of your application. 

5. Application for a permit, and the acceptance of a permit, each binds the 
applicant and licensee to compliance with the conditions stated above. Viola- 
tion of said conditions renders the permit, voidable and unless satisfactorily 
explained will result in the cancellation of the permit on the books of the 
health department. 

Wm. C. Woodward, M. D., 

Health Officer, 



794 

To the Health Officer, District of Columbia: 

In compliance with "An act to regulate the sale of milk in the District *of 
Columbia, and for other purposes," I hereby make application for a permit to 
send or bring milk into said District from the premises described below, located 

[Give name of road, nearest cross road, and anything that will aid the inspector in 

locating premises.] 

[Whole milk. 
Number of shipments per day Total number of gallons \ Skim milk. 

[Cream. 

Shipped in — Wagon Boat Railroad 

Time of delivery Place of delivery 

Consigned to 

Description of Premises. 

stable. 

Location : 

How far from the stable are the hogpens? 

How far from the stable is the manure stored? 

Is there any standing water near the stable? 

Is the stable used for any other than dairy purposes? 

Room for cattle: 

Size : Feet long feet wide average height, feet 

Total clear air space per stall, in cubic feet 

Floor : 

Kind : Cement Plank 

How drained? 

What becomes of the drainage? 

Lighting and ventilation : 

Number of windows : Glass Muslin curtain 

Total number of square feet in glass windows 

Total number of square feet in glass per stall 

Total number of square feet in muslin windows 

Total number of square feet in muslin windows per stall 

Number of adjustable windows Number of nonadjustable windows 

Ventilation other than by windows : 

Number of inlets Total area in square feet 

Number of outlets Total area in square feet 

Location of inlets 

Location of outlets 

Stalls : 

How many? Size of each, feet long _, feet wide 

What kind of tie is used for the cattle? 

Is bedding used for the cattle? Kind 

Feed mangers: 

Plank Cement 

If a continuous trough in front of the line of stalls, is each animal allotted 

space separated by a partition? 

How are feed troughs cleaned? 



795 

How are cattle watered? 

From well >. spring ' running strearn__ 

If from well, state location, distance, and slope of ground from- 

Nearest privy 

Hogpens 

Stable 

Barnyard 

Give the approximate depth of well feet 

How is well protected against surface drainage? 



Has the water any perceptible odor? color? taste?. 

BARNYARD. 



Size: Feet long feet wide 

What disposition is made of the drainage from the barnyard? 

Is manure stored in the barnyard? If so, is it protected by a 

barrier to prevent cattle from walking through it? 

If manure is not stored in barnyard, what disposition is made of it? 

DAIRY ROOM. 

Size. Feet long feet wide 

Construction of. Floor Walls Ceiling 

How is dairy room drained? 

Location. 

How far is dairy room located from stable? 

How far is dairy room located from privy? 

How far is dairy room located from manure pile? 

How far is dairy room located, from hogpens or any other source of con- 
tamination? , 

Is the dairy room effectually screened? 

Do you have a separate wash room for dairy utensils? 

If so, describe the same 



METHODS OF HANDLING MILK. 



Kind of receptacles used? 

How are the dairy utensils cleaned? 

How is water heated for cleaning dairy utensils? 

How much water can be heated at one time? 

Are dairy utensils sterilized with steam or boiling water? 

Are the dairy utensils aired in sunlight after cleaning? 

Is the milk cooled immediately after milking? 

Where is the milk cooled? 

How is the milk cooled? 

To what temperature is the milk cooled? 

Are cans of milk or cream iced during transportation in hot weather 

Are they covered with wet blanket? 

Do you use small top milking pail? 

Source of water supply for washing dairy utensils 



796 

If from well, state location, distance, and slope of ground from — 

Nearest privy 

Hogpens •_ 

Stable 

Barnyard 

Give the approximate depth of well feet. 

How is well protected against surface drainage? 

Has the water any perceptible odor? color? taste ?. 



PRIVY. 

Location 

Is the excreta deposited directly on ground or in a receptacle? 

If receptacle is used, is it water-tight? 

How often are the contents of the receptacle removed and where are they de- 
posited? 

Are covers provided for the seats? Is privy effectually screened? 



CATTLE. 

How many milch cows are usually kept? 

Have the dairy cattle been tuberculin tested? 

How are cows cleaned? How often 

Do milkers wash and wipe the udders before milking? 

Do milkers wash their hands before milking? 

What facilities are provided, if any, in the stable or dairy, or both, for cleansing 
the hands of those persons who work with or about the cattle or handle milk 

or the dairy utensils? 

Signature of Applicant 

Post-Office Address_<* 

Husband's Name 

[To be filled in if applicant is a married woman.] 

Veterinarian's Certificate. 

[The veterinarian's certificate must be from one who has regularly graduated from a 
veterinary medical college, or who practices under a license from a state examining 
board. If unable to secure the services of such, so state on your application blank, and, 
all other conditions being satisfactory, action will be suspended until this requirement is 
met, thus enabling you to send or bring milk into the District without violation of exist- 
ing law.] 

Sir : I have carefully examined the cattle upon the premises above referred 
to, and their condition is as follows: 

Signature 

Address 

Personally appeared before me this day of , 19 , the subscriber, 

who being duly sworn deposes and says that he is a veterinary surgeon practic- 
ing in accordance with the laws of the State in which he resides, and that he 
has personally examined the cattle referred to in the above statement and 
knows them to be the same as are referred to in the application to which the 
certificate is appended, and that their condition is correctly described without 
evasion or concealment. 

Signature 

Address 



797 

United States Department of Agriculture. 
Bureau of Animal Industry. 

AGREEMENT. 

In consideration of the testing of my herd of cattle by the Bureau of Animal 
Industry of the United States Department of Agriculture, and the assistance 
of said bureau in enabling me to produce and maintain a herd of cattle free 

from the contamination of tuberculosis, I, 

[Name of owner.] 

of , owner of said herd of cattle, 

[Post-office address.] 

comprising 

[Number and kinds over 6 months old ; number and kinds under 6 months old.] 

do hereby agree as follows : 

1. I will cause all animals which react to the tuberculin test, and which also 
show other marked symptoms of tuberculosis, to be slaughtered within a reason- 
able time under the United States meat-inspection regulations, and I will cause 
the carcasses of said animals to be disposed of according to the meat-inspection 
regulations of the Bureau of Animal Industry, based upon the lesions found 
upon inspection. 

2. I will cause all animals which react to the tuberculin test, but which show 
no other evidence of tuberculosis, either to be slaughtered and disposed of as 
herein provided for animals which show also other evidence of tuberculosis, or 
I will cause such animals to be removed from the herd and portion of the farm 
upon which the healthy animals of the herd are maintained, and I will cause 
the diseased animals to be segregated from the healthy animals, and thereafter 
they shall remain so segregated. 

3. In all cases where the milk from such segregated reacting cows is to be 
used for any purpose whatever I will cause the said milk to be sterilized.^ 

4. Segregated reacting bulls may be used for breeding, provided they are 
held on leash and are not permitted to leave the premises reserved for tbeir use, 
and provided the healthy cows bred to such bulls are not unduly exposed to 
infected premises or to other diseased cattle. 

5. I will cause the young from segregated reacting animals to be removed 
from their mothers at birth, and will not permit the said young to suck their 
mothers. 

6. Any of my premises contaminated by reacting animals will be submitted 
by me to a thorough disinfection under the direction or supervision of the 
Bureau of Animal Industry. 

7. All cattle owned by me, both healthy and tuberculous, I will mark, or 
allow to be marked, in such manner as to enable their identity to be retained, 
and I will not change the location of or slaughter any tuberculosis cattle except 
after due and timely notification to the Bureau of Animal Industry, stating the 
exact nature of the change of location, or the exact date, name, and address 
of the official establishment at which the animal or animals are to be slaugh- 
tered. 

8. I will add no cattle to the said herd which have not passed a tuberculin 
test with the tuberculin prepared by the Bureau of Animal Industry, admin- 

°An act to regulate the sale of milk in the District of Columbia states that 
it shall not be lawful for any person or persons to sell or offer for sale, within 
the District of Columbia, milk taken from any cow which is known to be suffer- 
ing from tuberculosis. 



798 

istered by a licensed veterinarian of the State, an authorized public agent 
qualified to perform such test, or by an inspector of the Bureau of Animal 
Industry : Provided, That I may purchase cattle to be added to my herd if the 
said cattle are kept effectually separated from the rest of my tuberculin-tested 
cattle until the same can be tuberculin tested, and I will immediately notify the 
Bureau of Animal Industry and the local board of health that these cattle are 
on my premises subject to test. 

9. I will comply with all reasonable sanitary measures which are indicated 
by the proper officials of the State or Territory wherein my herd is located, or 
by the local board of health under whose permit I am disposing of dairy 
products, or by the Bureau of Animal Industry. 

In witness whereof I have signed this agreement this day of 

, one thousand nine hundred and 

Owner of the herd. 

(Address) 

Witness : 



Application foe Permission to Maintain a Dairy within the District of 

Columbia. 

instructions to applicants. 

1. The act to regulate the sale of milk in the District of Columbia provides 
that " no person shall maintain a dairy within the District of Columbia without 
a permit so to do from the health officer of said District." 

2. This application should be made out in ink and signed with your full 
name. 

3. Under the law no permit can be issued until after the dairy to which this 
permit relates is found to conform to the regulations governing dairies and 
dairy farms within the District of Columbia. Immediately after the filing of 
the application, however, if it be in proper form, the applicant can lawfully 
begin business and continue the same until after his application has been acted 
upon by the health officer. An inspection of your premises will be made as 
soon as practicable after the filing of your application. 

4. A copy of the regulations above referred to is inclosed herewith. 

Wm. C. Woodward, M. D., 

Health Officer. 

To the Health Officer, District of Columbia. 

Sir : In compliance with "An act to regulate the sale of milk in the District 
of Columbia, and for other purposes," I hereby make application for a permit 
to maintain a dairy, described below, located 

[Give street and number.] 



799 

' DESCKIPTION OF PREMISES. 

Construction of building i . 

(Brick. 

Number and location of rooms used for dairy purposes 

Ventilation and light. Number of windows ; doors 

Floor: Wood, concrete, brick, brick and concrete 

How is the floor drained? 

State location of water-closets, privies, and urinals on the premises 

Are premises used for any purpose other than the sale of dairy products? If 

so, what? 

{Steam, 
Hot. 
Cold. 

Describe facilities for cleaning cans, bottles, and utensils 

Describe facilities for storing 

How is milk cooled? 

Is the dairy screened as required by law? 

rMilk. 
Gallons sold daily J Cream. 

[Buttermilk. 

Number of receptacles used ; kind 

Number of wagons 

List of shippers 

If business is to be operated under a trade name, please state such name 

Respectfully, 

Name 

Address 



Acknowledgment of Receipt of Applications. 

Commissioners of the District of Columbia, 

Health Department, 
Dairy and Dairy Farm Inspection Service, 

Washington, D. C, , 19—. 

This department is in receipt of your application for 

{conduct a dairy in 1 
conduct a dairy farm in Ithe District of Columbia, 
bring or send milk and cream into__J 
Having filed the said application you may now lawfully begin business and 
continue the same until final action has been taken upon your application. An 
inspection of your establishment will be made at an early date. 
Respectfully, 

, M. D., 

Health Officer. 

Please preserve this card as evidence of your authority to engage in the above business. 



800 

Health Department, District of Columbia. 
No 

DAIRY PERMIT. 

Permission is hereby granted to maintain a dairy at subject to 

regulations governing dairies within the District of Columbia. 

, M. D., 

Health Officer. 

, 190— 

Issued in accordance with an "Act to regulate the sale of milk in the District 
of Columbia, and for other purposes," approved March 2, 1895. 

This permit is not transferable, and applies only to the premises specified hereon. 
If location is changed, new permit is required. 



Health Department, District of Columbia. 

No 

DAIRY FARM PERMIT. 

Permission is hereby granted to maintain a dairy farm at subject 

to regulations governing dairy farms within the District of Columbia. 

M. D., 

Health Officer. 

, 190— 

Issued in accordance with an "Act to regulate the sale of milk within the 
District of Columbia, and for other purposes," approved March 2, 1895. 
This permit is not transferable. 



Health Department, District of Columbia. 
No 

MILK IMPORTER'S PERMIT. 

Permission is hereby granted to bring or send milk into the District 

of Columbia from the dairy farm located at and described in application 

No. , subject to the following conditions: 

That none but pure and unadulterated milk shall be, with knowledge of its 
impurity, brought into said District. 

That in the management of the dairy farm upon which the milk is produced, 
or at the dairy at which the milk is collected and stored prior to shipment, 
the applicant shall be governed by the regulations of the health office of the 
District of Columbia, approved by the Commissioners of said District, issued 
for dairies and dairy farms in said District, when said regulations do not 
confftct with the law of the State in which said dairy or dairy farm is located. 

That said dairy or dairy farm may be inspected at any time without notice 
by the health officer of the District of Columbia or his duly appointed repre- 
sentative. 

, M. D., 

Health Officer. 
,190— 

Issued in accordance with an "Act to regulate the sale of milk in the District 
of Columbia, and for other purposes," approved March 2, 1895. 

This permit is not transferable. 



801 

Notice of violation of dairy regulations. 

Any objection to this notice should be filed with the health officer before the 
expiration of the time allowed for making the changes specified. 

Health Department, District of Columbia. 
No 

DAIRY AND DAIRY FARM INSPECTION. 

Washington, 190.. 

Mr 

Sir : Your attention is called to the following violations of the Regulations for 
the Government of Dairies and Dairy Farms, which have been found to exist 
upon your premises : 



You are hereby notified to correct the same within days from the date 

of service of this notice. 

By order of the health officer. 



Inspector of Dairies and Dairy Farms. 



Cancellation of permit — preliminary inspector's notice. 

Health Department of the District of Columbia. 

dairy and dairy farm inspection. 

, 190— 

Mr 

Sir : An inspection of your dairy farm this date shows that you are violating 
the conditions under which your permit, Xo. , was issued, namely, 

You are therefore directed to show cause in writing to the health officer on 
or before , 190__. why your permit should not be canceled. 

By order of health officer. 



Inspector. 



Cancellation of permit — health officer's preliminary letter. 

Washington. , 190— 

Mr 

Sir : I have the honor to inform you that the report of Inspector , 

of this department, dated , 190__, shows that you are violating the condi- 
tions under which your permit, No. , to bring or send milk into the Dis- 
trict of Columbia was issued, namely. In view of this fact, you are 

hereby directed to show cause on or before why your permit should not be 

revoked. 

Respectfully, M. D.. 

Health Officer. 
45276°— Bull. 56—12 51 



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803 






Health Department of the District of Columbia, 
Dairy and Dairy-Farm Inspection Service. 

SCORE CARD FOR DAIRY FARMS. 

Farm of Location Consignee 

Permit number D. C, Md., Va. 19 Rating. 



Equipment. 



Cows, 16. 

Comfort: 

Bedding 

Temperature of stable 

Food 

Water: 

Clean 

Fresh 

Light: Four square feet or more 
of glass per cow 

(Three square feet, 3; 2 
square feet, 2; 1 square 
foot, 1.) 
Ventilation: Automatic system. 

(Adjustable windows, 1.) 
Cubic feet air space per cow, 

600 to 1,000 feet 

(Less than 600 feet, 2; less 
than 500 feet, 0.) 

Stables, 6. 

Location of stable: 

Well drained 

Free from contaminating 

surroundings 

Construction of stable: 

Tight, sound floor and 

proper gutter 

Smooth, tight walls and 

ceiling 

Proper stall, tie, and man- 
ger 



Utensils, 14. 



Construction of utensils 

Water for cleaning: Clean, con- 
venient, and sufficient 

Facilities for steam 

(Hot water sufficient to 
immerse utensils, 2.) 

Small- top milking pail 

Milk cooler 

Clean milking suits 



Handling the milk, 4. 

Location of milk room: 

Free from contaminating 

surroundings 

Convenient 

Construction of milk room: 
Floors, walls, and ceiling.. 
Light, ventilation, and 
screens 



Total. 



Score. 



Perfect. Allowed. 



40 



Methods. 



Cows and stables, 16. 

Cleanliness of stables: 

Floor 

Walls .. 

Ceiling and ledges 

Mangers and partitions. . . 

Windows 

Stable air 

Barnyard: Clean and well 

drained 

Removal of manure daily to 

field or pit 

(Manure stored less than 
50 feet from stable, 0.) 

Utensils and milking, 24. 

Care and cleanliness of uten- 
sils: 

Thoroughly cleansed 

Steaming or scalding uten- 
sils 

Inverting utensils in pure 

air and sunlight 

Cleanliness of milking: 

Clean, dry hands 

Udders washed and dried. 
(Udders cleaned with 
moist cloth, 4.) 

Handling the milk, 20. 



Cleanliness of attendants 

Milk of each cow removed im- 
mediately from the stable.. 

Cleanliness of milk room 

Prompt cooling (cooled im- 
mediately after milking 
each cow) 

Efficient cooling: Below 50° F. 
(51° to 55°, 4; 56° to 60°, 2.) 

Storage: Below 50° F 

(51° to 55°, 2; 56° to 60°, 1.) 

Transportation : Iced 

(For jacket or wet blanket 
allow 2; dry blanket or cov- 
ered wagon, 1.) 



Total. 



Score. 



Perfect. Allowed. 



CO 



Score for equipment + Score for methods = final score 

Source of water supply General condition of farm 

Violations of regulations, sec Violations of act, sec 

Notices served, to correct, to show cause by - 

Remarks 



Inspector. 



804 

Score for cattle. 

[Printed on back of score card for dairy farms.] 



Number cattle in dairy herd. 



Perfect score. 
For each cow or bull, 100. 



Total possible score for herd. 



Deductions on account of cattle diseased, etc. 



Number of 
cattle. 



Nature of disease, defect, etc. 



Deductions 
per cow. 



Total 
deductions. 



1. Tuberculosis as shown by a physical examination, or by the 

tuberculin test. 

2. Absence of a tuberculin test within one year of the date of 

inspection, not to include cattle scored under paragraph 1. 

3. Inflammatory diseases of the udder 

4. Diseases other than or in addition to the diseases mentioned 

above. 

5. Unclean condition of the teats and udders 

6. Unclean condition of the cows other than specified in the 

preceding paragraph 

7. Undue emaciation or cows otherwise out of condition 



100 
30 



100 or less 
100 or less 



40 or less 
30 or less 



10 or less 



Total deduction for herd. 
Net score- 



Net score ( ) divided by the total possible score for herd ( ) equals 

percentage score 

Remarks 



Inspector. 

The health department believes that if a cow is suffering from tuberculosis, her entire 
value as a dairy cow is gone. If she is suffering from an inflammatory disease of the 
udder, as well as from tuberculosis, she becomes even a greater danger to the herd. 
And if she is furthermore otherwise diseased, or out of condition, or dirty, she becomes 
even a more serious menace to public health. For these reasons the above system of 
scoring has been arranged so that an individual cow may count against the score of the 
entire herd more than would have been allotted to her had she been in perfect condition. 

All cows stabled with the dairy herd or found in the milking line will be scored as part 
of the herd. 



805 



Health Department of the District of Columbia. 

Dairy and Dairy Farm Service. 

score card for dairies. 

Owner or manager Trade name 

Street and No Permit No 

Number of wagons fMilk 

Gallons sold daily I Cream 

Date of inspection 190 (.Buttermilk- 



Equipment. 



Plant: 

Location 10 

Convenience 

Surroundings 

Arrangement 5 

Proper rooms 

Convenience 

Construction 10 

Floor and drainage 

Walls 

Ceiling 

Light 

Ventilation 

Screens , 

Machinery and utensils. 30 

(Kind, quality, condi- 
tion, and arrange- 
ment.) 

Bottle and can washer. 

Bottling machine 

Capping machine 

Crates, racks, etc 

Cold storage 

Pasteurizer 

Water for cleaning 20 

Steam 

Hot water 

Cold water 

Salesroom 10 

Location 

Construction 

Equipment 



Additional deductions for ex- 
ceptionally bad conditions. 



Total deductions . 
Net total 



Score. 



Perfect. Allowed. 



100 



Methods. 



Plant: 

Cleanliness 15 

Floor 

Walls 

Ceilings 

Doors 

Windows 

Good order 

Free from odors 

Freedom from flies . . . 

Machinery and utensils- 
Cleanliness 

Milk— (Handling) .... 20 

Clarifying 

Bottling 

Pasteurizing 

Storage T 

45° F. or below... 20 

45° to 50° F 15 

50° to 55° F 10 

Salesroom- 
Cleanliness 

Attendants' cleanli- 



Additional deductions for ex- 
ceptionally bad conditions. 



Total deductions . 
Net total 



Score. 



Perfect. Allowed 



100 



Score for equipment 

Score for methods 

Total to be divided by 3. 
Final score 



multiplied by 1. 
multiplied by 2. 



Supplemental score for wagons. 


Perfect. 


Allowed. 


This score does not cover quality of milk pur- 




3 

7 




chased by this dealer. 


Condition 














10 







Inspector. 



806 



Collection of samples — Inspector's memorandum and label. 



I. S. No , 190.. Sold as. 

Label 



Bought by dealer of. 
Dealer 



Salesman Price paid. 

Bought by on 

Delivered to on 

Remarks 



per 

at { a P 

'* {p.m! 



m. 
p. m. 



Inspector's description of sample. 



Inspector. 



Bureau of 


Chemistry. 


I. S 


.No. 


Bureau of 


Chemistry. 


I. S. 


No. 


Bureau of 


Chemistry. 


I. S. 


No. 







Health Department of the District of Columbia, 

Washington, , 190-. 

REPORT OF ANALYSIS. 



Substances offered for sale or sold as — 
Milk Cream Skimmed milk- 
by 

at on 



Analysis. 





1 


2 


3 


4 


5 


6 


7 


8 


9 


10 




Per 
cent. 


Per 
cent. 


Per 

cent. 


Per 
cent. 


Per 
cent. 


Per 
cent. 


Per 
cent. 


Per 
cent. 


Per 
cent. 


Per 
cent. 


Fat 












































* Water 






















*Odor 






















* Acidity 

























































































*A check indicates that no test was made for the ingredient or quality checked. 

Remarks 

, Analyst. 

Legal standards: Milk. — Not less than 3| per cent fat, 9 per cent solids not fat, and not 
more than 87 \ per cent water. 
Cream. — Not less than 20 per cent fat. 

Skimmed milk. — Not less than 9& per cent solids, including fat. 
Wholesome milk must come from healthy cows living under proper sanitary conditions. 
It must have been properly cared for at the time of milking and continually thereafter ; 
especially must it have been kept cold. This report shows the chemical composition of 
the milk analyzed, but indicates only in an imperfect manner its wholesomeness, which 
can be determined only by considering the condition of the cows, dairy farm, and dairy 
in connection with this analysis. 



807 

There is as yet no fixed standard for acidity in milk, but any sample of milk or cream 
found to be, in the judgment of the health department, too acid will be regarded as 
unwholesome, and the seller prosecuted accordingly. The sale of milk, cream, or skimmed 
milk which has been colored or to which a preservative of any sort has been added is in 
violation of law. 

Dealers in foodstuffs, including, of course, milk, etc., are required by law to know at 
all times the quality of all goods which they sell. Prosecutions will therefore be insti- 
tuted in suitable cases without notice. 

, M. D., 

Health Officer. 

To 

Exhibit D. 

Laws and regulations relating to the production and sale of milk in the District 

of Columbia. 

ACTS OF CONGRESS. 
AN ACT To regulate the sale of milk in the District of Columbia, and for other purposes. 

Be it enacted by the Senate and House of Representatives of the United States 
of America in Congress assembled, That from and after the passage of this act 
do person shall, within the District of Columbia, keep or maintain a dairy or 
dairy farm without a permit so to do from the health officer of said District; 
application for said permit shall be made in writing, upon a form prescribed by 
said health officer : Provided, That no applicant for said permit shall be 
restrained from conducting business until said application has been acted upon 
by the health officer of the District of Columbia or his duly appointed agent. 
It shall be the duty of said health officer, upon receipt of said application in 
due form, to make or cause to be made an examination of the premises which 
it is intended to use in the maintenance of said dairy or dairy farm ; if after 
such examination said premises are found to conform to the regulations govern- 
ing dairies and dairy farms within the District of Columbia, said health officer 
shall issue the permit hereinbefore specified, without charge : Provided, That 
said permit may be suspended or revoked at any time, without notice, by said 
health officer whenever the milk supply from said dairy or dairy farm is exposed 
to infection by Asiatic cholera, anthrax, diphtheria, erysipelas, scarlet fever, 
smallpox, splenic fever, tuberculosis, typhoid fever, typhus fever, or yellow fever, 
so as to render its distribution dangerous to public health. 

Sec 2. That no person shall bring or send into the District of Columbia for 
sale any milk without a permit so to do from the health officer of said District ; 
application for said permit shall be made in writing, upon a form prescribed by 
said health officer, and shall be accompanied by such detailed description of the 
dairy farm or dairy where said milk is produced or stored as said health officer 
may require, and by a sworn statement as to the physical condition of the cattle 
supplying said milk: Provided, That no applicant for said permit shall be 
restrained from conducting business until said application has been acted upon 
by the health officer of the District of Columbia or his duly appointed agent. 
If after examination of said application said health officer is satisfied that said 
milk will be brought into the District of Columbia for sale or consumption 
without danger to public health, he shall issue, without charge to the applicant, 
a permit so to do, on condition that none but pure and unadulterated milk shall 
be, with knowledge of its impurity, brought into said District ; that in the man- 
agement of said dairy or dairy farm said applicant shall be governed by the 
regulations of the health office of the District of Columbia, approved by the 
Commissioners of the District of Columbia, issued for dairies and dairy farms 



808 

in said District, when said regulations do not conflict with the law of the State 
in which said dairy or dairy farm is located, and that said dairy or dairy farm 
may be inspected at any time without notice by the health officer of the District 
of Columbia or his duly appointed representative: Provided, That said permit 
may be suspended or revoked at any time without notice by said health officer 
whenever the milk supply from said dairy or dairy farm is exposed to infection 
by Asiatic -cholera, anthrax, diphtheria, erysipelas, scarlet fever, smallpox, 
splenic fever, tuberculosis, typhoid fever, typhus fever, or yellow fever, so as to 
render its distribution dangerous to public health. 

Sec. 3. That no person suffering from, or who has knowingly, within a period 
specified by the health officer of the District of Columbia, been exposed to diph- 
theria, scarlet fever, erysipelas, smallpox, anthrax, or other dangerous con- 
tagious disease, shall work or assist in or about any dairy or dairy farm ; no 
proprietor, manager, or superintendent of any dairy or dairy farm within 
the District of Columbia shall knowingly permit any person suffering, or ex- 
posed as aforesaid, to work or assist in or about said dairy or dairy farm. 

Sec. 4. That all milk wagons shall have the name of the owner, the number 
of permit, and the location of dairy from which said wagons haul milk, painted 
thereon plainly and legibly. 

Sec. 5. That all grocers, bakers, and other persons having or offering for sale 
milk shall at all times keep the name or names of the dairymen from whom the 
milk on sale shall have been obtained posted up in a conspicuous place wherever 
such milk may be sold or kept for sale. 

Sec 6. That no person shall offer or have for sale in the District of Columbia 
any unwholesome, watered, or adulterated milk, or milk known as swill milk, 
or milk from cows that are fed on swill, garbage, or other like substance, nor 
any butter or cheese made from any such milk. 

Sec 7. (Repealed by act of February 17, 1898. See Wiegand v. D. C, 31 
Wash. Law Rep., 730.) 

Sec 8. That no person shall sell, exchange, or deliver, or have in his custody 
or possession with intent to sell, exchange, or deliver, skimmed milk containing 
less than nine and three-tenths per cent of milk solids, inclusive of fat. 

Sec 9. That no dealer in milk, and no servant or agent of such a dealer, shall 
sell, exchange, or deliver, or have in his custody or possession with intent to 
sell, exchange, or deliver, milk from which the cream, or any part thereof, has 
been removed, unless in a conspicuous place, above the center or upon the out- 
side of every vessel, can, or package thereof, in which milk is sold, the words 
" skimmed milk " are distinctly marked in gothic letters, not less than one inch 
in length. 

Sec 10. That it shall not be lawful for any person or persons to sell or offer 
for sale, within the District of Columbia, milk taken from any cow less than 
fifteen days before or ten days after parturition, or from any cow which is 
known to be suffering from tuberculosis, splenic fever, anthrax, or any general 
or local disease which is liable to render the milk from said cow unwholesome. 

Sec 11. That it shall be the duty of the health officer of the District of Co- 
lumbia, under direction of the Commissioners of said District, to make and 
enforce regulations to secure proper water supply, drainage, ventilation, air 
space, floor space, and cleaning of all dairies and dairy farms within said 
District ; to secure the isolation of cattle suffering from any contagious disease, 
and to carry into effect the provisions of this act. 

Sec 12. That the health officer of the District of Columbia, or his duly ap- 
pointed assistants, shall have the right to enter, without previous notice, for 
the purpose of inspection, any dairy or dairy farm within said District. 






809 

Sec. 13. (Repealed by act of February 17, 1898. See Weigand v. D. C, 31 
Wash. Law Rep., 730.) 

Sec. 14. That prosecutions under this act shall be in the police court of said 
District, on information signed by the attorney of the District or one of his 
assistants, and any person or persons violating any of the provisions of this 
,act shall be deemed guilty of a misdemeanor, and shall, on conviction, be pun- 
ished for the first offense by a fine of not less than five dollars nor more than 
twenty-five dollars, to be collected as other fines and penalties, or by imprison- 
ment in the workhouse for a period of not more than thirty days, and for the 
second offense and each subsequent offense, by a fine of not less than fifty 
dollars nor more than one hundred dollars, or by imprisonment in the work- 
house for ninety days, or by both such fine and imprisonment, in the discretion 
of the court, and if the person so convicted of a second or subsequent offense 
hold a permit under this act, the same shall be canceled and no permit shall 
be issued to said person for a period of six months: Provided, That any person 
or persons under this act shall have the privilege, when demanded, of a trial 
by jury as in other jury cases in the police court. 

Sec. 15. That all laws and parts of laws inconsistent with the foregoing be, 
and the same are hereby, repealed. 

Approved, March 2, 1895. 



AN ACT Relating to the adulteration of foods and drugs in the District of Columbia. 

[30 Stats., 246.] 

Be it enacted by the Senate and House of Representatives of the United 
States of America in Congress assembled, That no person shall, within the Dis- 
trict of Columbia, by himself or by his servant or agent, or as the servant or 
agent of any other person, sell, exchange, or deliver, or have in his custody or 
possession with the intent to sell or exchange, or expose or offer for sale or 
exchange, any article of food or drug which is adulterated within the meaning 
of this act. 

Sec. 2. That the term " drug," as used in this act, shall include all medicines 
for external or internal use, antiseptics, disinfectants, and cosmetics. The term 
" food," as used herein, shall include confectionery, condiments, and all articles 
used for food or drink by man, and if there be more than one quality of any 
article of food or drug known by the same name the best quality thereof shall 
be furnished to the purchaser, unless he otherwise requests at the time of mak- 
ing such purchase, or unless he be notified at such time of the inferior quality 
of the article delivered. 

Sec. 3. That an article shall be deemed to be adulterated within the meaning 
of this act : 

( a ) In the case of drugs : First, if, when sold under or by a name recognized 
in the United States Pharmacopoeia, it differs from the standard of strength, 
quality, or purity laid down in the edition thereof at the time official ; second, 
if, when sold under or by a name not recognized in the United States Pharma- 
copoeia, but which is found in the German, French, or English Pharmacopoeia, 
it differs from the strength, quality, or purity laid down therein ; third, if, when 
sold as a patented medicine, compounded drug, or mixture it is not composed of 
all the ingredients advertised or printed or written on the bottles, wrappers, or 
labels of or on or with the patented medicine, compounded drug, or mixture: 
Provided, That if the defendant in any prosecution under this act, in respect to 
the sale of any such patented medicine, compounded drug, or mixture, shall 



810 

prove to the satisfaction of the court that he had purchased the article in ques- 
tion as the same in nature, substance, and quality as that demanded of him by 
the purchaser, and with a written warranty to that effect ; that he had no rea- 
son to believe at the time when he sold it that the article was otherwise, and 
that he sold it in the same state as when he purchased it, he shall be discharged 
from the prosecution. 

(b) In the case of food: First, if any substance or substances have been 
mixed with it so as to reduce or lower or injuriously affect its quality or 
strength; second, if an inferior or cheaper substance or substances have been 
substituted wholly or in part for it ; third, if any valuable constitutent has been 
wholly or in part abstracted from it ; fourth, if it is an imitation of or is sold 
under the name of another article ; fifth, if it consist wholly or in part of a de- 
ceased, decomposed, putrid, or rotten animal or vegetable substance, whether 
manufactured or not; sixth, if it is colored, coated, polished, or powdered 
whereby damage is concealed, or if it is made to appear better or of greater 
value than it really is; seventh, if it contains any added poisonous ingredient 
or any ingredient which may render it injurious to the health of a person 
consuming it ; eighth, in the case of milk, if it contains less than three and one- 
half per centum of fat, less than nine per centum of solids not fat, and contains 
more than eighty-seven and one-half per centum of water ; in the case of cream, 
if it contains less than twenty per centum of butter fat; ninth, in the case of 
butter or cheese, if it is not made exclusively from milk or cream, or both, with 
or without common salt ; the butter, if it contains more than twelve per centum 
of water, more than five per centum of salt, and less than eighty-three per 
centum of fat ; tenth, in the case of coffee, if it is not composed entirely of the 
seed of the Caffea arabica ; eleventh, in the case o.f lard, if it is not made exclu- 
sively from the rendered fat of the healthy hog; twelfth, in the case of tea, 
if it is not composed entirely of the genuine leaf of the tea plant not exhausted ; 
thirteenth, in the case of all kinds of vinegar, if it contains an acidity equiva- 
lent to the presence of less than four per centum of absolute acetic acid; and 
cider vinegar, if it is not made from the pure apple juice and contains less than 
one and five-tenths per centum of total solids; fourteenth, in the case of cider, 
if it is not made from the legitimate product of pure apple juice; in the case 
of wines and fruit juices, if not made from the pure fruit as represented ; and 
in the case of cider, wines, fruit juices, and malt liquors, if not free from sali- 
cylic acid or other preservatives ; and in the case of malt liquors, if not free 
from picric acid, cocculus indicus, colchicine, colocynth, aloes, and wormwood; 
fifteenth, in the case of glucose, if it contains more than five one-hundredths 
per centum of ash ; sixteenth, in the case of flour, if it is not composed entirely 
of one single ground cereal ; seventeenth, in the case of bread, if there is any 
addition of alum, sulphate of copper, borax, or sulphate of zinc, or other poi- 
sonous or harmful ingredient, and if it contains more than thirty-one per centum 
of moisture, more than two per centum of ash, and less than six and twenty-five 
one-hundredths per centum of albuminoids; eighteenth, in the case of olive oil, 
if it is not made exclusively from the olive berry (Olea europsea), and its spe- 
cific gravity at fifteen and six-tenths degrees centigrade ; ( sixty degrees Fahren- 
heit) " actual density " to be not more than nine hundred and seventeen one- 
thousandths nor less than nine hundred and fourteen one-thousandths: Pro- 
vided, That an offense shall not be deemed to be committed under this section 
in the following cases, that is to say, first, where the order calls for an article 
of food or drug inferior to such standard, or where such difference is made 
known by being plainly written or printed on the package; second, where the 
article of food or drug is mixed with any matter or ingredient not injurious to 



811 

health and not intended fraudulently to increase its bulk, weight, or measure 
or conceal its inferior quality, if at the time such article is delivered to the pur- 
chaser it is made known to him that such article of food or drug is so mixed. 

Sec. 4. That it shall be the duty of the health officer of the District of Colum- 
bia, under the direction of the Commissioners of said District, to adopt such 
measures as may be necessary to facilitate the enforcement hereof, and prepare 
rules and regulations with regard to the proper method of collecting and exam- 
ining drugs and articles of food in said District. 

Sec. 5. That it shall be the duty of the health officer to investigate a com- 
plaint for a violation of any of the provisions of this act on the information of 
any person who lays before him satisfactory evidence by which to substantiate 
such complaint. 

Sec. 6. That every person offering for sale or delivering to any purchaser any 
drug or article of food included in the provisions of this act shall furnish to any 
analyst or other officer or agent of the health department, who shall apply to 
him for the purpose and shall tender him the value of the same, a sample suf- 
ficient for the purpose of analysis of any such drug or article of food which is 
in his possession. 

Sec. 7. That in all cases where any drug or article of food shall be taken as a 
sample to be examined and analyzed the person making the analysis shall re- 
serve a portion of the sample, which shall be sealed, for a period of thirty days 
from the time of taking such sample, and in case of a complaint the reserved 
portion alleged to be adulterated shall, upon application, be delivered to the 
defendant or his attorney. 

Sec 8. That no person shall hinder, obstruct, or in any way interfere with 
any inspector, analyst, or other person of the health department in the perform- 
ance of his duty in carrying out the provisions of this act. 

Sec. 9. That all prosecutions under this act shall be in the police court of said 
District, on information brought in the name of the District of Columbia, and 
on its behalf; and any person or persons violating any of the provisions of this 
act shall be deemed guilty of a misdemeanor, and upon conviction shall be pun- 
ished by a fine of not less than five dollars nor more than one hundred dollars. 

Sec. 10. That all acts and parts of acts inconsistent with this act be, and the 
same are hereby, repealed : Provided, That nothing in this act contained shall 
be construed as modifying or repealing any of the provisions of "An act defining 
butter, also imposing a tax upon and regulating the manufacture, sale, importa- 
tion, and exportation of oleomargarine," approved August second, eighteen hun- 
dred and eighty-six, or of "An act defining cheese, and also imposing a tax upon 
and regulating the manufacture, sale, importation, and exportation of ' filled 
cheese,' " approved June sixth, eighteen hundred and ninety-six. 

Approved, February 17, 1898. 



AN ACT To prevent the adulteration of candy in the District of Columbia. 
[30 Stat., 398.] 

Be it enacted by the Senate and House of Representatives of the United States 
of America in Congress assembled, That no person or corporation shall, by 
himself, his servant, or agent, or as the servant or agent of any other person 
or corporation, manufacture for sale or knowingly sell or offer to sell any 
candy adulterated by the admixture of terra alba, barytes, talc, or any other 
mineral substance, by poisonous colors or flavors, or other ingredients delete- 
rious or detrimental to health. 



812 

Sec. 2. That any person or corporation convicted of violating any of the 
provisions of this act shall be punished by a fine not exceeding one hundred 
dollars. The candy so adulterated shall be forfeited and destroyed under the 
direction of the court. 

Sec. 3. That it is hereby made the duty of the prosecuting attorneys of the 
District of Columbia to appear for the people and to attend to the prosecution 
of all complaints under this act in all the courts of said District. 

Sec. 4. That this act shall take effect upon its passage. 

Approved, May 5, 1898. 



AN ACT For preventing the manufacture, sale, or transportation of adulterated or mis- 
branded or poisonous or deleterious foods, drugs, medicines, and liquors, and for regu- 
lating traffic therein, and for other purposes. 

Be it enacted by the Senate and House of Representatives of the United 
States of America in Congress assembled, That it shall be unlawful for any 
person to manufacture within any Territory or the District of Columbia any 
article of food or drug which is adulterated or misbranded, within the meaning 
of this act; and 'any person who shall violate any of the provisions of this 
section shall be guilty of a misdemeanor, and for each offense shall, upon con- 
viction thereof, be fined not to exceed five hundred dollars or shall be sentenced 
to one year's imprisonment, or both such fine and imprisonment, in the discre- 
tion of the court, and for each subsequent offense and conviction thereof shall 
be fined not less than one thousand dollars or sentenced to one year's impris- 
onment, or both such fine and imprisonment, in the discretion of the court. 

Sec 2. That the introduction into any State or Territory or the District of 
Columbia from any other State or Territory or the District of Columbia, or 
from any foreign country, or shipment to any foreign country of any article of 
food or drugs which is adulterated or misbranded, within the meaning of this 
act, is hereby prohibited ; and any person who shall ship or deliver for shipment 
from any State or Territory or the District of Columbia to any other State 
or Territory or the District of Columbia, or to a foreign country, or who 
shall receive in any State or Territory or the District of Columbia from any 
other State or Territory or the District of Columbia, or foreign country, and 
having so received, shall deliver, in original unbroken packages, for pay or 
otherwise, or offer to deliver to any other person, any such article so adulterated 
or misbranded within the meaning of this act, or any person who shall sell or 
offer for sale in the District of Columbia or the Territories of the United States 
any such adulterated or misbranded foods or drugs, or export or offer to export 
the same to any foreign country, shall be guilty of a misdemeanor, and for such 
offense be fined not exceeding two hundred dollars for the first offense, and 
upon conviction for each subsequent offense not exceeding three hundred dollars 
or be imprisoned not exceeding one year, or both, in the discretion of the court : 
Provided, That no article shall be deemed misbranded or adulterated within the 
provisions of this act when intended for export to any foreign country and pre- 
pared or packed according to the specifications or directions of the foreign pur- 
chaser when no substance is used in the preparation or packing thereof in con- 
flict with the laws of the foreign country to which said article is intended to be 
shipped ; but if said article shall be in fact sold or offered for sale for domestic 
use or consumption, then this proviso shall not exempt said article from the 
operation of any of the other provisions of this act. 

Sec 3. That the Secretary of the Treasury, the Secretary of Agriculture, and 
the Secretary of Commerce and Labor shall make uniform rules and regulations 
for carrying out the provisions of this act, including the collection and examina- 



813 

tion of specimens of foods and drugs manufactured or offered for sale in the 
District of Columbia, or in any Territory of the United States, or which shall 
be offered for sale in unbroken packages in any State other than that in which 
they shall have been respectively manufactured or produced, or which shall be 
received from any foreign country, or intended for shipment to any foreign 
country, or which may be submitted for examination by the chief health, food, 
or drug officer of any State, Territory, or the District of Columbia, or at any 
domestic or foreign port through which such produce is offered for interstate 
commerce, or for export or import between the United States and any foreign 
port or country. 

Sec. 4. That the examinations of specimens of foods and drugs shall be made 
in the Bureau of Chemistry of the Department of Agriculture, or under the 
direction and supervision of such bureau, for the purpose of determining from 
such examinations whether such articles are adulterated or misbranded within 
the meaning of this act ; and if it shall appear from any such examination that 
any of such specimens is adulterated or misbranded within the meaning of this 
act, the Secretary of Agriculture shall cause notice therof to be given to the 
party from whom such sample was obtained. Any party so notified shall be 
given an opportunity to be heard, under such rules and regulations as may be 
prescribed as aforesaid, and if it appears that any of the provisions of this act 
have been violated by such party, then the Secretary of Agriculture shall at 
once certify the facts to the proper United States district attorney, with a copy 
of the results of the analysis or the examination of such article duly authenti- 
cated by the analyst or officer making such examination, under the oath of such 
officer. After judgment of the court, notice shall be given by publication in 
such manner as may be prescribed by the rules and regulations aforesaid. 

Sec. 5. That it shall be the duty of each district attorney to whom the Secre- 
tary of Agriculture shall report any violation of this act, or to whom any health 
or food or drug officer or agent of any State, Territory, or the District of 
Columbia shall present satisfactory evidence of any such violation, to cause 
appropriate proceedings to be commenced and prosecuted in the proper courts 
of the United States, without delay, for the enforcement of the penalties as in 
such case herein provided. 

Sec 6. That the term " drug " as used in this act shall include all medicines 
and preparations recognized in the United States Pharmacopoeia or National 
Formulary for internal or external use, and any substance or mixture of sub- 
stances intended to be used for the cure, mitigation, or prevention of disease 
of either man or other animals. The term " food," as used herein, shall 
include all articles used for food, drink, confectionery, or condiment by man 
or other animals, whether simple, mixed, or compound. 

Sec 7. That for the purposes of this act an article shall be deemed to be 
adulterated : 

In case of drugs: 

First. If, when a drug is sold under or by a name recognized in the United 
States Pharmacopoeia or National Formulary, it differs from the standard of 
strength, quality, or purity, as determined by the test laid down in the United 
States Pharmacopoeia or National Formulary official at the time of investiga- 
tion : Provided, That no drug defined in the United States Pharmacopoeia or 
National Formulary shall be deemed to be adulterated under this provision if 
the standard of strength, quality, or purity be plainly stated upon the bottle, 
box, or other container thereof, although the standard may differ from that 
determined by the test laid down in the United States Pharmacopoeia or Na- 
tional Formulary., 



814 

Second. If its strength or purity fall below the professed standard or quality 
under which it is sold. 

In the case of confectionery: » 

If it contains terra alba, barytes, talc, chrome yellow, or other mineral sub- 
stance or poisonous color or flavor, or other ingredient deleterious or detri- 
mental to health, or any vinous, malt, or spirituous liquor or compound or 
narcotic drug. • 

In the case of food : 

First. If any substance has been mixed and packed with it so as to reduce 
or lower or injuriously affect its quality or strength. 

Second. If any substance has been substituted wholly or in part for the 
article. 

Third. If any valuable constituent of the article has been wholly or in part 
abstracted. 

Fourth. If it be mixed, colored, powdered, coated, or stained in a manner 
whereby damage or inferiority is concealed. 

Fifth. If it contain any added poisonous or other added deleterious ingredient 
which may render such article injurious to health: Provided, That when in 
the preparation of food products for shipment they are preserved by any ex- 
ternal application applied in such manner that the preservative is necessarily 
removed mechanically, or by maceration in water, or otherwise, and directions 
for the removal of said preservative shall be printed on the covering or the 
package, the provisions of this act shall be construed as applying only when 
said products are ready for consumption. 

Sixth. If it consists in whole or in part of a filthy, decomposed, or putrid 
animal or vegetable substance, or any portion of an animal unfit for food, 
whether manufactured or not, or if it is the product of a diseased animal, or 
one that has died otherwise than by slaughter. 

Sec. 8. That the term " misbranded " as used herein shall apply to all drugs, 
or articles of food, or articles which enter into the composition of food, the 
package or label of which shall bear any statement, design, or device regarding 
such article, or the ingredients or substances contained therein which shall be 
false or misleading in any particular, and to any food or drug product which 
is falsely branded as to the State, Territory, or country in which it is manu- 
factured or produced. 

That for the purposes of this act an article shall also be deemed to be mis- 
branded : 

In case of drugs : 

First. If it be an imitation of or offered for sale under the name of another 
article. 

Second. If the contents of the package as originally put up shall have been 
removed, in whole or in part, and other contents shall have been placed in such 
package, or if the package fail to bear a statement on the label of the quantity 
or proportion of any alcohol, morphine, opium, cocaine, heroin, alpha or beta 
eucaine, chloroform, cannabis indica, chloral hydrate, or acetanilide, or any 
derivative or preparation of any such substances contained therein. 

In the case of food : 

First. If it be an imitation of or offered for sale under the distinctive name of 
another article. 

Second. If it be labeled or branded so as to deceive or mislead the purchaser, 
or purport to be a foreign product when not so, or if the contents of the package 
as originally put up shall have been removed in whole or in part and other 
contents shall have been placed in such package, or if it fail to bear a statement 
on the label of the quantity or proportion of any morphine, opium, cocaine, 



815 

heroin, alpha or beta eucaine, chloroform, cannabis indica, chloral hydrate, or 
acetanilide, or any derivative or preparation of any of such substances contained 
therein. 

Third. If in package form, and the contents are stated in terms of weight or 
measure, they are not plainly and correctly stated on the outside of the package. 

Fourth. If the package containing it or its label shall bear any statement, 
design, or device regarding the ingredients or the substances contained therein, 
which statement, design, or device shall be false or misleading in any par- 
ticular : Provided, That an article of food which does not contain any added 
poisonous or deleterious ingredients shall not be deemed to be adulterated or 
misbranded in the following cases : 

First. In the case of mixtures or compounds which may be now or from time 
to time hereafter known as articles of food, under their own distinctive names, 
and not an imitation of or offered for sale under the distinctive name of another 
article, if the name be accompanied on the same label or brand with a statement 
of the place where said article has been manufactured or produced. 

Second. In the case of articles labeled, branded, or tagged so as to plainly 
indicate that they are compounds, imitations, or blends, and the word " com- 
pound," " imitation," or " blend," as the case may be, is plainly stated on the 
package in which it is offered for sale: Provided, That the term blend as used 
herein shall be construed to mean a mixture of like substances, not excluding 
harmless coloring or flavoring ingredients used for the purpose of coloring and 
flavoring only: And provided further, That nothing in this act shall be con- 
strued as requiring or compelling proprietors or manufacturers of proprietary 
foods which contain no unwholesome added ingredient to disclose their trade 
formulas, except in so far as the provisions of this act may require to secure 
freedom from adulteration or misbranding. 

Sec. 9. That no dealer shall be prosecuted under the provisions of this act 
when he can establish a guaranty signed by the wholesaler, jobber, manu- 
facturer, or other party residing in the United States, from whom he pur- 
chases such articles, to the effect that the same is not adulterated or mis- 
branded within the meaning of this act, designating it. Said guaranty, to 
afford protection, shall contain the name and address of the party or parties 
making the sale of such articles to such dealer, and in such case said party or 
parties shall be amenable to the prosecutions, fines, and other penalties which 
would attach, in due course, to the dealer under the provisions of this act. 

Sec. 10. That any article of food, drug, or liquor that is adulterated or mis- 
branded within the meaning of this act, and is being transported from one 
State, Territory, District, or insular possession to another for sale, or, having 
been transported, remains unloaded, unsold, or in original unbroken packages, 
or if it be sold or offered for sale in the District of Columbia or the Territories, 
or insular possessions of the United States, or if it be imported from a foreign 
country for sale, or if it is intended for export to a foreign country, shall be 
liable to be proceeded against in any district court of the United States within 
the district where the same is found, and seized for confiscation by a process 
of libel for condemnation. And if such article is condemned as being adul- 
terated or misbranded, or of a poisonous or deleterious character, within the 
meaning of this act, the same shall be disposed of by destruction or sale, as 
the said court may direct, and the proceeds thereof, if sold, less the legal costs 
and charges, shall be paid into the Treasury of the United States, but such 
goods shall not be sold in any jurisdiction contrary to the provisions of this 
act or the laws of that jurisdiction : Provided, however, That upon the pay- 
ment of the costs of such libel proceedings and the execution and delivery of a 



816 

good and sufficient bond to the effect that such articles shall not be sold or 
otherwise disposed of contrary to the provisions of this act, or the laws of any 
State, Territory, District, or insular possession, the court may by order direct 
that such articles be delivered to the owner thereof. The proceedings of such 
libel cases shall conform, as near as may be, to the proceedings in admiralty, 
except that either party may demand trial by jury of any issue of fact joined 
in any such case, and all such proceedings shall be at the suit of and in the 
name of the United States. 

Sec. 11. The Secretary of the Treasury shall deliver to the Secretary of Agri- 
culture, upon his request from time to time, samples of foods and drugs which 
are being imported into the United States or offered for import, giving notice 
thereof to the owner or consignee, who may appear before the Secretary of 
Agriculture, and have the right to introduce testimony, and if it appear from 
the examination of such samples that any article of food or drug offered to be 
imported into the United States is adulterated or misbranded within the mean- 
ing of this act, or is otherwise dangerous to the health of the people of the 
United States, or is of a kind forbidden entry into, or forbidden to be sold or 
restricted in sale in the country in which it is made or from which it is 
exported, or is otherwise falsely labeled in any respect, the said article shall be 
refused admission, and the Secretary of the Treasury shall refuse delivery to 
the consignee and shall cause the destruction of any goods refused delivery 
which shall not be exported by the consignee within three months from the 
date of notice of such refusal, under such regulations as the Secretary of the 
Treasury may prescribe : Provided, That the Secretary of the Treasury may 
deliver to the consignee such goods pending examination and decision in the 
matter on execution of a penal bond for the amount of the full invoice value of 
'such goods, together with the duty thereon, and on refusal to return such 
goods for any cause to the custody of the Secretary of the Treasury, when 
demanded, for the purpose of excluding them from the country, or for any 
other purpose, said consignee shall forfeit the full amount of the bond : And 
provided further, That all charges for storage, cartage, and labor on goods 
which are refused admission or delivery shall be paid by the owner or con- 
signee, and in default of such payment shall constitute a lien against any 
future importation made by such owner or consignee. 

Sec. 12. That the term " Territory " as used in this act shall include the 
insular possessions of the United States. The word " person " as used in this 
act shall be construed to import both the plural and the singular, as the case 
demands, and shall include corporations, companies, societies, and associations. 
When construing and enforcing the provisions of this act, the act, omission, 
or failure of any officer, agent, or other person acting for or employed by any 
corporation, company, society, or association, within the scope of his employ- 
ment or office, shall in every case be also deemed to be the act, omission, or 
failure of such corporation, company, society, or association as well as that of 
the person. 

Sec 13. That this act shall be in force and effect from and after the first 
day of January, nineteen hundred and seven. 

Approved, June 30, 1906. 



817 

AN ACT To amend section eight hundred and seventy-eight of the Code of Law for the 

District of Columbia. 

Be it enacted by the Senate and House of Representatives of the United States 
of America in Congress assembled, That section eight hundred and seventy- 
eight of the Code of Law for the District of Columbia be, and the same is 
hereby, amended by adding thereto the following: 

" Sec. 878a. That the following words shall, in addition to their ordinary 
meaning, have the meaning herein given : The word ' person ' or ' persons,' in 
sections eight hundred and seventy-eight b, c, d, e, and g, inclusive, shall include 
' firms ' or ' corporations ; ' the word ' vessel ' or ' vessels ' in sections eight 
hundred and seventy-eight b, c, d, and e, shall include ' cans,' ' bottles,' ' siphons,' 
and ' boxes ;' the word ' mark ' or ' marks ' shall include ' labels,' ' trade-marks,' 
and all other methods of distinguishing ownership in vessels, whether printed 
upon labels or blown into bottles or engraved and impressed upon cans or boxes. 

" Sec. 878b. That persons engaged in producing, manufacturing, bottling, or 
selling milk or cream, or any other lawful beverage composed principally of 
milk, in vessels, with their name, trade-mark, or other distinctive mark, and 
the word ' registered ' branded, engraved, blown, or otherwise produced thereon, 
or on which a pasted trade-mark label is put upon which the word ' registered ' 
is also distinctly printed, may file with the clerk of the supreme court of the 
District of Columbia a description by facsimile, or a sample of an original 
package so marked or branded or blown, showing plainly such names and 
marks thereon, together with their name in full, or their corporate name, and 
also their place of business in the District of Columbia, and if so filed shall 
cause the same to be published for not less than two weeks successively in a 
daily or weekly newspaper published in the District of Columbia. 

" Sec. 878c. That whoever, except the person who shall have filed and pub- 
lished a description of the same as aforesaid, fills with milk or cream, or other 
beverage, as aforesaid, with intent to sell the same, any vessel so marked and 
distinguished as aforesaid, the description of which shall have been filed and 
published as provided in the preceding section, or defaces, erases, covers up, or 
otherwise removes or conceals any such name or mark as aforesaid, or the word 
* registered,' thereon, or sells, buys, gives, takes or otherwise disposes of, or 
traffics in the same without having purchased the contents thereof from the per- 
son whose name is in or upon such vessel, or without the written consent of 
such person, shall, for the first offense, be punished by a fine of not less than 
fifty cents for each such vessel, or by imprisonment for not less than ten days 
nor more than one year, or both such fine and imprisonment ; and for each 
subsequent offense by a fine of not less than one or more than five dollars for 
each such vessel, or by imprisonment for not less than twenty days nor more 
than one year, or by both such fine and imprisonment. 

" Sec. 878d. That the use or possession by any person not engaged in the pro- 
duction or sale of milk or cream or other beverage as aforesaid, except the 
person who shall so have filed and published a description of the same as afore- 
said, of any vessel marked or distinguished as aforesaid, the description of 
which shall have been filed and published as aforesaid, without purchase of the 
contents thereof from, or the written consent of, the person who shall so have 
filed and published the said description, shall be prima facie evidence of the un- 
lawful use, possession of, or traffic in, such vessel, and the person so using or in 
possession of the same, except the person who shall so have filed and published 
the said description as aforesaid, shall be punished as in the next preceding 
section provided. 

45276°— Bull. 56—12 52 



818 

" Sec. 878e. That upon complaint of any person who has complied with section 
eight hundred and seventy-eight b, or his agent, to the police court of the Dis- 
trict of Columbia, or one of the judges thereof, that such person, or agent, has 
reason to believe, and does believe, that any person within the District of Co- 
lumbia is guilty of the violation of any provision of this act, the said court or 
judge may issue a search warrant to discover and obtain such vessels as afore- 
said and their contents, and may also cause to be brought before the said court 
or judge the person so believed to be guilty, or his agent or employee, in whose 
possession or upon whose wagon or premises any such vessel or vessels may be 
found ; and any such person, agent, or employee found guilty of a violation of 
any of the provisions of this act shall be punished as aforesaid, and the said 
court or judge shall also order the property taken upon any such search war- 
rant to be delivered to its owner. 

" Sec. 878f. That the clerk of the supreme court of the District of Columbia 
is hereby authorized to make regulations and prescribe forms for the filing of 
labels, trade-marks, or other distinctive marks under the provisions of the fore- 
going amendments to section eight hundred and seventy-eight. 

" Sec. 878g. That nothing in the foregoing amendments to section eight hun- 
dred and seventy-eight shall prevent or restrain any person who is the legal 
owner of a trade-mark or label from proceeding in an action of tort against any 
person found guilty of violating any subsection of section eight hundred and 
seventy-eight." 

Approved, February 27, 1907. 



Orders of the Commissioners of the District of Columbia. 

POLICE REGULATIONS. 

Cow yards, pens, or stables. 

Article XIX. Section 1. No person shall establish or maintain a cow yard, 
pen, or stable within any of the more densely populated parts of the District of 
Columbia, within two hundred feet of any building used as a dwelling house, 
manufactory, store, or place of public assemblage, without the written consent of 
the owner of such building; such consent to be renewed upon the first day of 
July of each year upon thirty days' notice by the health officer to that effect : 
Provided, That nothing in this section shall be construed to prevent a person 
from keeping one cow for his own domestic use, nor to prevent the sale of the 
surplus milk by a person keeping a cow for his own domestic use. 

Sec 2. Any person violating any of the provisions of this regulation shall, 
upon conviction thereof, be punished by a fine of not more than five dollars for 
each day during which such violation shall continue. — Order of August 28, 1897. 

BUILDING REGULATIONS. 
Location of dairies. 

Sec 170a. No dairy nor establishment for the storage or sale of milk or 
other dairy products, which shall involve in its use or operation more than two 
wagons, shall be established or located in any square or block fronting on any 
street or avenue where more than one-half of the improved property in such 
square or block fronting on such street or avenue is used for residential pur- 
poses, nor shall any such dairy or establishment be located in any square or 
block fronting on any alley of which more than three-fourths of the improved 
property in such square or block is used for residential purposes, except with 



819 

the written consent of the owners of three-fourths of the property within two 
hundred feet of the boundaries of the site on which such dairy or establishment 
is proposed to be located : Provided, That this regulation shall not apply to any 
case of rebuilding or enlarging, in the same location, any existing dairy or 
establishment for the storage or sale of milk or other dairy products. — Order of 
April 17, 1906. 

KEGULATIONS FOB THE GOVERNMENT OF DAIRIES AND DAIRY FARMS. 

Ordered, That the following regulations made by the health officer of the 
District of Columbia, pursuant to the requirements of section 11 of "An act to 
regulate the sale of milk in the District of Columbia, and for other purposes," 
approved March 2, 1895, in lieu of the regulations on the same subject made 
and approved June 26, 1895, are hereby approved : 

Section 1. No building or space shall be used for dairy purposes which is 
not well lighted and ventilated, which is not provided with a suitabJe floor, 
and, if such room or space be a cellar or subcellar, or be located in a cellar or 
subcellar, which is not properly concreted, guttered, and drained. 

Sec 2. No dairy shall be located or maintained within any kitchen, wash 
room, workshop, or inhabited room, nor in proximity to any water-closet, privy, 
cesspool, or urinal, nor in any room or space which is not of such size and con- 
struction as to permit the entire separation of all milk and milk products, both 
in the process of handling and storing the same, from all probable sources of 
contamination, either by dirt, noxious gases, infective organisms or substances, 
or anything liable to alter unnecessarily the quality of such milk or milk 
products. 

Sec 3. Every person maintaining a dairy shall provide for the use thereof, 
and shall use, a sufficient number of receptacles, made of nonabsorbent material, 
for the reception, storage, and delivery of milk, and shall cause them to be 
kept clean and wholesome at all times; and having delivered any such recep- 
tacle to a consumer shall not again use the same for the reception, storage, 
or delivery of milk or cream in any form until it has been, to his personal 
knowledge, properly cleaned after such use. 

Sec 3a. Elsewhere than in the proper parts of premises which have been 
duly constructed and equipped, and which are duly maintained for the handling, 
storage, and sale of milk or cream, no person shall fill or partly fill with milk 
or cream any receptacle intended for delivery to a customer unless such recep- 
tacle, at the time of filling, be furnished by the customer for whose service such 
receptacle is intended. — (Amendment of July 14, 1903.) 

Sec 4. Every person maintaining a dairy shall provide for the use thereof 
a supply of pure and suitable water, sufficient for the proper washing of all 
cans, bottles, and appliances. 

Sec 5. Every person maintaining a dairy shall keep the same and all ap- 
purtenances thereto clean and wholesome at all times, and shall change the 
water in the coolers at least once each day. 

Sec 6. No building shall be used for stabling cows for dairy purposes which 
is not well lighted, ventilated, drained, and constructed, or which is not pro- 
vided with stalls or with proper stanchions for anchoring the cows, so arranged 
as to allow not less than three and one-half feet width of space for each milch 
cow; or which is not provided with good and sufficient facilities for feeding 
the animals in a cleanly manner ; or which contains less than six hundred cubic 
feet clear air space for each cow, unless the use of such building for stabling 
cows for dairy purposes has been authorized prior to the promulgation of these 



820 

regulations, in which case it shall contain not less than five hundred cubic feet 
clear air space for each cow. 

Sec. 7. No room shall be used for stabling cows for dairy purposes which con- 
tains any water-closet, privy, cesspool, urinal, or manure pit, nor shall any fowl, 
hog, horse, sheep, or goat be kept in any room used therefor. 

Sec. 8. Every person using any premises for keeping cows for dairy purposes 
shall, when so directed by the health officer, erect and maintain in the stable, 
stall, shed, or yard connected therewith one or more proper receptables for 
drinking water for such cows, and shall keep the same supplied with clean, fresh 
water, and none other. 

Sec. 9. Every person using any premises for keeping cows for dairy purposes 
shall keep the entire premises clean and in good repair and the buildings well 
painted or whitewashed. 

Sec 10. Every person using any premises for keeping cows for dairy purposes 
shall cause the dung to be removed from the stables at least twice daily, and 
always within one hour preceding every milking of the cows ; and shall not allow 
any accumulation of dung within the building occupied by the cows, but shall, 
whenever in the opinion of the health officer it is required by local conditions 
and surroundings, provide temporary storage for the same and for other refuse 
in a separate place, which shall be covered, and which, when so ordered by said 
health officer, shall be a water-tight receptacle. 

Sec. 11. Every person keeping cows for dairy purposes within the city of 
Washington or its more densely populated suburbs, or elsewhere in the District 
of Columbia, if, in the opinion of the health officer, local conditions require it, 
shall cause the inclosure in which such cows are kept to be graded and drained 
so as to keep the surface reasonably dry and to prevent the accumulation of 
water therein, except as may be permitted for the purpose of supplying drinking 
water ; and shall not permit any garbage, urine, fecal matter, or similar sub- 
stance to be placed or to remain in such inclosure, nor any open drain to run 
through it. 

Sec 12. Every person keeping cows for the production of milk for sale shall 
cause them to be kept clean and wholesome at all times, and shall cause the 
teats and, if necessary, the udder to be carefully cleaned by brushing, washing, 
or wiping before milking, and shall cause each such cow to be properly fed and 
watered. 

Sec 13. Any person using any premises for keeping cows for dairy purposes 
shall provide and use a sufficient number of receptacles, of nonabsorbent 
material, for the reception, storage, and delivery of milk, and shall keep them 
clean and wholesome at all times, and at milking time shall remove each recep- 
tacle, as soon as filled, from the stable or room in which the cows are kept ; nor 
shall any milk or cream be stored or kept within any room used for stabling 
cows or other domestic animals. 

Sec 14. It shall be the duty of every person having charge or control of any 
premises upon which cows are kept to notify the health officer of the District of 
Columbia of the existence of any contagious or infectious disease among such 
cows, by letter delivered or mailed, within twenty-four hours after the discovery 
thereof, and to thoroughly isolate any cow or cows so diseased, or which may 
reasonably be believed to be infected, and to exercise such other precautions as 
may be directed in writing, by said health officer. 

Sec 15. Milkers and those engaged in the handling of milk or cream shall 
maintain strict cleanliness of their hands and persons while milking or while 
so engaged. It shall be the duty of every person holding a permit to maintain 
a dairy or dairy farm to enforce this regulation in reference to such persons 
as may assist them in the maintenance thereof. 



821 

Sec. 16. That any person violating any of the foregoing regulations shall, on 
conviction thereof in police court, be punished by a fine of not more than ten 
dollars for each and every such offense, to be collected as other fines and pen- 
alties are collected. 

Sec 17. That the regulations for the government of dairies and dairy farms 
in the District of Columbia promulgated June 26, 1895, are hereby repealed. — 
Order of July SI, 1897. 



AN ORDINANCE To prevent the sale of unwholesome food in the cities of Washington 
and Georgetown, as amended by Commissioners' orders May 15, 1871. 
[Except as otherwise indicated these ordinances were promulgated by the board of 
health May 15, 1871, and have been legalized by Congress on April 24, 1880, and again on 
August 17, 1894.] 

Sec. 2. That no person shall offer for sale within the District of Columbia 
any liquor used for drink, whether malt, vinous, or ardent, or the milk of cows 
or goats, intended to be used for food or drink, which has been adulterated 
with any poisonous or deleterious ingredient ; and any person violating the pro- 
visions of this section shall, upon conviction, be punished by a fine of not less 
than ten nor more than fifty dollars for each and every such offense. 

Sec 5. That no person, whether owner, manager, keeper of, agent, bartender, 
or clerk, in any saloon, restaurant, boarding house, or eating house, located 
within the District of Columbia, shall offer for sale as food or drink anything 
poisonous or unwholesome; and any person violating the provisions of this 
section shall, upon conviction thereof, be punished by a fine of not less than 
five nor more than twenty-five dollars for each and every such offense. 

Sec 6a. That any person in the District of Columbia who receives milk or 
cream for sale shall, immediately after emptying the receptacle in which such 
milk or cream has been received, thoroughly rinse such receptacle so as to free 
the same from all remnants of milk and of cream, or shall cause such receptacle 
to be so rinsed ; and no person in said District shall put or, having power and 
authority to prevent, permit to be put into any receptacle which is commonly 
used for the storage or delivery of milk or cream for sale anything which is 
filthy or offensive or any refuse matter of any kind. Any person violating the 
provisions of this section shall, upon conviction thereof, be punished by a fine 
not exceeding twenty-five dollars for each and every such offense. — Commis- 
sioners'' regulation of April 21, 1903. 

Sec 6b. That no occupant of any building, room, stand, stall, or other place 
in the District of Columbia where cattle, sheep, hogs, poultry, or other animals 
are slaughtered or killed, and no occupant of any building, room, stand, stall, 
or other place in said District where milk, game, poultry, fish, vegetables, fruits, 
groceries, or other articles of food are prepared, kept, sold, or offered for sale, 
shall permit such place or an appurtenance thereto to be unnecessarily unclean 
and unwholesome. No person who slaughters or kills in said District any cat- 
tle, sheep, hogs, poultry, or other animals, and no person who prepares, keeps, 
sells, or offers for sale any meat, game, poultry, fish, vegetables, fruits, grocer- 
ies or other article of food, shall permit any implement, knife, measure, or 
utensil used in connection therewith to be unnecessarily unclean or unwhole- 
some or in unfit condition for use in connection with the slaughtering or killing 
of cattle, sheep, hogs, poultry, or other animals, or for the preparation, keeping, 
selling, offering for sale, and delivery of meat, game, poultry, fish, vegetables, 
fruits, groceries, or other articles of food. 

Any person who violates any of the provisions of this regulation shall, upon 
conviction thereof, be punished by a fine of not more than twenty-five dollars 
for each and every offense. — Commissioners' Regulation of October 6, 1904. 



822 

Sec 6c. No person shall expose for sale on any public highway, or in any 
uninclosed market, store, shop, stand, or stall, or on any open lot, or transport 
over any public highway for sale either by himself or by any other person, in 
the District of Columbia, any meat, fish, plucked poultry or game bird, dressed 
rabbit or squirrel, butter, butterine, oleomargarine, lard, lard compound or 
substitute, cheese, candy, cake, bread, dates, figs, or any food whatsoever of a 
kind not ' commonly washed, peeled, shelled, or cooked before being eaten, 
unless the same be effectually and in a cleanly manner wrapped, or covered 
and inclosed, so as to protect it from dust and insects. 

No person shall expose for sale in any place aforesaid between April 1 and 
October 31, inclusive, of any year, any fresh meat or fresh fish unless said meat 
or fish, while thus exposed, be kept at a temperature not exceeding fifty-five 
degrees Fahrenheit. — Commissioners' Regulation of May 11, 1909. 

Sec. 6f. No vendor or distributor of foods or beverages in the District of 
Columbia for immediate consumption on or about the place of business of such 
vendor or distributor shall permit any cup, glass, spoon, or fork that has been 
used for or in connection with the consumption of any such food or beverage 
to be used again for the same purpose until after it has been thoroughly washed 
in clean water. 

Any person violating any of the provisions of Sec. 6c, Sec. 6d, Sec. 6e, or 
Sec. 6f, shall be punished by a fine of not less than one dollar nor more than 
twenty-five dollars for every such violation. — Commissioners' 1 Regulation of 
April 24, 1906. 

Sec 7. That no person shall offer for sale within the District of Columbia any 
unwholesome, watered, or adulterated milk, or swill milk, or milk from cows 
kept up and fed on garbage, swill, or other deleterious substance ; nor shall any 
person offer for sale within said District any butter or cheese made from such 
unwholesome milk ; and any person violating the provisions of this section shall, 
upon conviction, be punished by a fine of not less than five nor more than twenty 
dollars for each and every such offense. 

Sec. 12. Every manager of a store, market, cafe, lunch room, or of any other 
place where a food or a beverage is manufactured or prepared for sale, stored 
for sale, offered for sale, or sold, which store, cafe, lunch room, or other place 
is in operation at the time of the promulgation of this regulation, shall, on or 
before July 1, 1907, register his full name, and the location of said store, market, 
cafe, lunch room, or other place, and the nature of the business transacted, in 
a book to be kept in the health office for that purpose ; and every manager of a 
store, market, cafe, lunch room, or other place where a food or beverage is 
manufactured or prepared for sale, stored for sale, offered for sale, or sold, 
that is first opened for business after the promulgation of this regulation shall, 
within five days after the opening of said store, market, cafe, lunch room, or 
other place, register in like manner. In event of a change in the manager or in 
the location of any store, market, cafe, lunch room, or other place aforesaid, 
the manager thereof shall call at the health office within five days after such 
change takes place and make a corresponding entry. Any person who violates 
the provision of this regulation shall, upon conviction thereof, be punished by 
a fine not exceeding twenty-five dollars for each and every such offense. — Com- 
missioners' 1 Regulation of April 5, 1907. 

Sec 13. Every manager of a store, market, dairy, cafe, lunch room, or any 
other place in the District of Columbia where a food, or a beverage, or confec- 
tionery, or any similar article, is manufactured or prepared for sale, stored for 
sale, offered for sale, or sold, shall cause it to be screened effectually, or effectu- 
ally protected by power-driven fan or fans, so as to prevent flies and other 
insects from obtaining access to such food, beverage, confectionery, or other 






823 

article, and shall keep such food, beverage, confectionery, or other article free 
from flies and other insects at all times. Any person violating the provisions 
of this regulation shall, upon conviction thereof, be punished by a fine of not 
more than twenty-five dollars for each and every such offense. This regulation 
shall take effect from and after the expiration of thirty days immediately 
following the date of its promulgation. — Commissioners' Regulation of April 11, 
1908. 

Sec. 14. Every manager of a store, market, dairy, cafe, lunch room, or of any 
other place in the District of Columbia where a food, or a beverage, or confec- 
tionery, or any similar article, is manufactured or prepared for sale, stored for 
sale, offered for sale, or sold, shall equip said store, market, dairy, cafe, lunch 
room, or other place, with running water, or other proper water supply if run- 
ning water be not available, and with facilities and material for the proper 
washing, and shall cause such washing to be done, of the hands of all persons 
employed therein, and for the proper cleansing, and shall cause such cleansing 
to be done, of said store, market, dairy, cafe, lunch room, or other place, and 
of all apparatus, utensils, and materials used in connection therewith. Any 
persons violating the provisions of this regulation shall, upon conviction thereof, 
be punished by a fine of not more than twenty-five dollars for each and every 
such offense. This regulation shall take effect from and after the expiration 
of thirty days immediately following the date of its promulgation. — Commis- 
sioners' Regulation of May SI, 1907, as amended by orders of June 10, 1907, 
and April 11, 1908. 

Sec. 15. No person shall use any premises or any part of any premises in the 
District of Columbia for the preparation, manufacture, or storage for sale, or 
for the offering for sale, exchange, or delivery, of any food, drink, confectionery, 
or condiment for man, unless such premises or part of premises be provided 
with running water, or other proper water supply if running water be not avail- 
able, and with all necessary facilities, apparatus, and material for the proper 
cleansing of said premises or part of premises, and of all apparatus, utensils, 
and materials used in connection therewith, and for the proper cleansing of 
the hands of all the persons employed therein. Any person violating any of 
the provisions of this section shall, upon conviction thereof, be punished by a 
fine of not more than twenty-five dollars for each and every such offense, and 
each day's violation shall be deemed to be a separate offense. — Commissioners 1 
Regulation of November 17, 1908. 

Regulations for the Prevention of the Spread of Scarlet Fever, Diph- 
theria, Measles, Whooping Cough, Chicken Pox, Epidemic Cerebro-Spinal 
Meningitis, and Typhoid Fever. 

Sec. 5. No person residing in any dwelling house or in any apartments where 
there is in said dwelling house or apartments a patient suffering from diph- 
theria, scarlet fever, measles, or epidemic cerebro-spinal meningitis, shall, while 
so residing and during the continuance of such case, attend public or private 
school or Sunday school, or if the patient was suffering from diphtheria or 
scarlet fever, engage in the manufacture, preparation, storage, or sale of food 
or beverage. 

Sec. 6. No person who has resided in any dwelling house or in any apart- 
ments while there wr z in such dwelling house or apartments a patient suffering 
from scarlet fever, diphtheria, measles, or epidemic cerebro-spinal meningitis 
shall after the removal, death, or recovery of the patient, or after the removal 
of such person from such dwelling house or apartments, attend public or private 
school, or Sunday school, or, if the patient was suffering from scarlet fever or 



824 

diphtheria, engage in the manufacture, preparation, or storage of food or a 
beverage for sale, or in the sale of food or a beverage, without the written 
permission of the health officer, for a period following the first proper isolation 
of the patient, when no disinfection is to be made, and when disinfection is 
necessary immediately following the completion of such disinfection, as may be 
directed by the health officer, and continuing if the patient was suffering from 
scarlet fever, diphtheria, or epidemic cerebro-spinal meningitis, for seven days, 
or if the patient was suffering from measles, for fourteen days. — Commissioners' 
Regulations of April 5, 1907. 



Establishing a Limit of Tolerance on Milk Bottles or Jars. 

July 29, 1901. 

Ordered: That the schedule of fees for inspecting and sealing glass bottles 
or jars used for the distribution or delivery of milk or cream to consumers, 
adopted June 17, 1901, and suspended July 1 and July 10, 1901, is hereby 
amended to read as follows, to take effect on and after the first of August, 
1901: 

That the glass bottles or jars used for the distribution or delivery of milk or 
cream to consumers, that hold, when filled to a level with the bottom of the 
cap or stopple, not less than seven ounces and six drams and not over eight 
ounces and two drams for one-half pint measure; not less than fifteen ounces 
and five drams and not over sixteen ounces and four drams for one pint; not 
less than thirty-one ounces and four drams and not over thirty-two ounces and 
four drams for one quart ; not less than forty-seven ounces and three drams 
and not over forty-eight ounces and five drams for three pints; not less than 
sixty-three ounces and two drams and not over sixty-four ounces and six drams 
for one-half gallon, shall be sealed as measures and that all dealers in milk 
who use glass bottles or jars for the distribution or delivery of milk or cream 
to consumers shall be charged a fee of fifty cents per hundred bottles for such 
inspection and sealing, — (Commissioners order of July 29, 1901.) 






AUTHOR IIDEX. 

Page. 
Anderson, John F.: The frequency of tubercle bacilli in the market milk of the city of Wash- 
ington, D. C 165 

The relation of goats' milk to the spread of Malta fever 199 

The relative proportion of bacteria in top milk (cream layer) and bottom milk (skim 

milk), and its bearing on infant feeding 737 

Bolton, B. Meade: Sanitary water supplies for dairy farms 573 

Methods and results of the examination of water supplies of dairies supplying the District 

of Columbia 589 

Eager, J. M. : Morbidity and mortality statistics as influenced by milk 233 

Kastle, Joseph H., and Roberts, Norman: The chemistry of milk 313 

Kerr, J. W.: Certified milk and infants' milk depots 611 

Lumsden, Leslie L.: The milk supply of cities in relation to the epidemiology of typhoid 

fever 151 

McCoy, George W.: Milk sickness 215 

and Rosenau, Milton J.: The germicidal property of milk 455 

Melvin, A. D. : The classification of market milk 605 

Miller, William W.: The significance of leucocytes in milk 489 

Mohler, John R. : Conditions and diseases of the cow injuriously affecting the milk 499 

Roberts, Norman, and Kastle, Joseph H. : The chemistry of milk 313 

Rosen atj, Milton J. : The number of bacteria in milk and the value of bacteria counts 427 

Pasteurization 637 

The thermal death points of pathogenic micro-organisms in milk ■. 681 

and McCoy, George W. : The germicidal property of milk 455 

Schereschewsky, Joseph W. : Infant feeding 687 

Schroeder, E. C. : The relation of the tuberculous cow to public health 527 

Stiles, Ch. Wardell: The relation of cow's milk to the zooparasitic diseases of man 227 

Trask, John W.: Milk as a cause of epidemics of typhoid fever, scarlet fever, and diphtheria. . 237 

Webster, Ed. H. : Sanitary inspection and its bearing on clean milk 557 

Wiley, Harvey W.: Ice cream 249 

National inspection of milk 741 

Woodward, Wm. Creighton: The municipal regulation of the milk supply of the District of 

Columbia 745 

Wyman, Walter: Milk and its relation to the public health; introduction 13 

(825) 



SUBJECT INDEX 



Page. 

Acid-fast organisms in milk 165, 180 

Actinomycosis 518 

Adulteration of milk 18, 381 

Agglutination of milk bacteria 470 

Air and dust 44 

Amsterdam, milk supply of 449, 451 

Anderson, John F 17, 18, 22, 165, 201, 739 

Anthrax 519 

Antibodies in milk 457 

Artificial feeding of infants 241, 715, 726 

Bacilli: 

In milk 17, 

19, 27, 165, 201, 427, 489, 657, 681, 703, 737 

Thermal death points of 681 

Tubercle, in milk 17, 165 

Bacillus pseudo-tuberculosis, in milk 181 

Bacillus tuberculosis, in milk 17, 165 

Bacillus carriers 41, 154 

Bacteria: 

In milk 17, 

19, 27, 165, 201, 259, 427, 489, 657, 681, 703, 737 

Thermal death points of 681 

Bacteriology of ice cream 255 

Baltimore, milk supply of 452, 453 

Barns, care of 571 

Berlin, milk supply of 174, 176, 177, 178, 453 

Bertillon identification of cows 777 

Bitter milk 523 

Bolton, B. Meade 20, 573 

Boric acid in milk 385 

Boston, milk supply of 450, 452 

Botryomycosis 519 

Bottles 46 

Bottom milk, bacteria in 737 

Bovine tuberculosis 502, 527 

Breast feeding 708 

Breasts, care of woman's 709 

British Royal Commission on Tuberculosis. . 19 

Buffalo, milk supply of 451 

Bureau of Animal Industry 19, 21 

Bureau of Chemistry 21 

Butter: 

Tubercle bacilli in 507 

Typhoid in 153 

Calcutta, milk supply of 451 

Cambridge, milk supply of 175 

Care of milk 563 

Cattle: 

Diseases of 247,499,527 

Score card 804 

Tubercular 178 

Tuberculosis ' 19 



Page. 

Certified milk 20,608,611,613 

Changes in milk: 

Bacterial 359 

Chemical 315 

Charities, milk, abroad 243 

Charitable institutions, milk supply of 196 

Cheese: 

Typhoid in 154 

Tubercle bacilli in 508 

Chemistry of— 

Ice cream 253 

Milk 18,313 

Chicago: 

Milk supply of 452 

Pasteurization law 644 

Cholera in milk 247 

Cisterns 585 

Cities, milk supply of 157 

City distributing plant 564 

Classification of market milk 605 

Clean milk 557, 702 

Cold milk 704 

Collecting milk 617 

Colored milk ; 384, 399, 524 

Coloring matter 18 

Colostrum 524, 697 

Commercial pasteurization 675 

Co mmi ssions, milk 615 

Composition of milk 316, 705 

Consumption of milk 235 

Contaminated milk 44, 431, 523, 559, 704 

Copenhagen, milk supply of 170 

Cows: 

Care of 570 

Diseases of 499 

Housing of 617 

Tubercular 178 

Cow's milk in infant feeding 15 

Cowpox 519 

Cream: 

Bacteria in 258, 737 

Chemical data 252 

Dairies: 

Sanitary inspection of 20 

Score card 805 

Surroundings 616 

Water supply of 20, 589, 616 

Dairy business, precautions in 571 

Dairy: 

Dangers of 157 

Distributing 564 

Farms, inspection of 772 

(827) 



828 



Page. 
Dairy— Continued. 

Farms, water supply on 573 

Inspection 779 

Score-card system 564 

Death points of bacteria, thermal 681 

Death rates in the District of Columbia 791 

Delivery of milk 618 

Denmark, milk supply of 178 

Depots: 

Certified milk 611 

For infants' milk 629 

Pasteurized milk 241- 

Destruction of typhoid in milk 163 

Diarrheal diseases 238 

Diet, milk as a 244 

Diphtheria 145 

Epidemics 107 

Milk as a cause of 23, 34 

Mortality 247 

Dirt in milk 18, 398, 523 

Diseases of cows 247, 499, 514, 527 

Distributing plant 564 

District of Columbia: 

Bovine tuberculosis in 506 

Cream in 258 

Government of 789 

Ice cream in 255 

Milk laws 748 

Pure-food laws 809 

Milk supply of 396,437 

Regulation of milk supply of 745 

Score-card system 803 

Typhoid fever in 15 

Water supply of dairies in 589 

Dorpat, milk supply of 450 

Drug laws, District of Columbia 809 

Dust and air 44 

Dysentery from milk 227 

Eager, John M 235 

England, milk supply of 178 

Epidemic, typhoid 158 

Epidemics due to milk 17, 23, 246 

Epidemiology of typhoid fever 157 

Europe, milk supply of 453 

Farms, dairy: 

Inspection of 772 

Water for 573 

Feeding of— 

Cows 617 

Infants 241, 656, 687, 737 

Ferments, milk, destruction temperature of. . 18 
Fever. 

Malta 199 

Typhoid, in the District of Columbia. . . 15 

Food laws in the District of Columbia 809 

Foot and mouth disease 247, 514 

Formaldehyde in milk 389 

Freezing milk 477 

Fresh milk 703 

Garget 520 

Gastro-enteritis 521 

Genoa, milk supply of 173 

German commission on tuberculosis 19 

Germicidal property of milk 19, 455 

Gibraltar fever 201 

Giessen, milk supply of. 17, 450 

Goat's milk 199 



Page. 

Government of the District of Columbia 789 

Government standards for milk 18 

Grocery milk 157 

Halle, milk supply of. 172, 449 

Hand feeding of infants 241 

Handling of milk, and precautions in 571, 617 

Health v. milk 235 

Heating milk 477 

Home, care of milk at 158 

Home pasteurization 665 

Hookworms in milk 227 

Houses, milk 563,571 

Housing of cows 617 

Hygienic Laboratory, examination of milk at . 17 

Ice cream 18,249 

Ice cream, typhoid in 153 

Infant feeding 21, 241, 656, 687, 737 

Infant mortality 15, 236, 239, 240, 689 

Infant's milk depots 611, 629 

Infected milk 704 

Inspected milk 609 

Inspection 747 

Inspection of— 

Milk 741 

Milk and dairies 21 

Inspection, sanitary 557 

Intestinal diseases 238 

Introduction 15 

Kastle, Joseph H 18,315 

Kerr, John W 20,613 

Konigsburg, milk supply of 174 

Laws: 

Concerning pasteurization 643 

Milk, of District of Columbia 748 

Legal standards for milk 18 

Leipzig, milk supply of 450 

Leucocytes in milk 19, 489, 520 

Licenses in the District of Columbia 793 

Liverpool, milk supply of 174 

London, milk supply of 17, 177, 451 

Lumsden, Leslie L 17, 153 

Magruder, G. Lloyd 16 

Malta fever 199 

Mammitis 520 

Manchester, milk supply of 174, 177 

Margarine, tubercle bacilli in 509 

Market milk: 

Classification of 605 

Of Washington 165 

Maryland, springs and wells of 589 

Massachusetts, pasteurization law of 643 

Medical milk commissions 615 

Mediterranean fever 199 

Melvin, A. D 20,607 

McCoy, George W 18,217,457 

Micrococcus melitensis in milk". 201 

Microorganisms: 

In milk 17, 

19, 27, 165, 201, 427, 489, 651, 681, 703, 737 

Thermal death points of 681 

Middletown, Conn., milk supply of 451 

Milk commissions 615 

Milk depots: 

Certified 611 

Infants' 629 

Pasteurized 241 

Milk epidemics 23,51,246 



829 



Page. 

Milk houses, and care of 5C3, 571 

Milk inspection 780 

Milk poisoning 372 

Milk sickness 18, 215, 522 

Milk supply of the District of Columbia 745 

Milk supply of various cities and countries. 
(See under the names of cities, etc.) 

Milk utensils 562 

Milking, and precautions in 560, 571 

Miller, William W 19,491 

Modification of milk 723 

Mohler, John R 19,501 

Montclair typhoid epidemic 46 

Morbidity influenced by milk 233 

Mortality: 

Influenced by milk 233 

Infant 15, 236, 239, 240, 689 

Rates in the District of Columbia 291 

Mother's milk v. cow's milk 15 

Mother's milk 239, 697 

Munich, milk supply of 449,450 

Municipal regulation in the District of 

Columbia 745 

New York: 

Infant mortality in 242 

Milk supply of 17, 451, 452 

Pasteurized milk in 241 

New York County medical milk commission . 625 

Nursing infants 708 

Odor of milk 524 

Organization of milk commissions 620 

Padua, milk supply of 177 

Parasites in milk 18,227 

Pasteurization 19, 20, 163, 506, 637, 727 

Definition 731 

Pasteurized milk 609 

Pasteurized-milk depots 241 

Pennington, M. E 255 

Permits, District of Columbia 793 

Phagocytosis 474 

Philadelphia, milk supply of 452 

Poisoning by milk 372, 524, 657 

Precautions in dairy business 571 

Preservatives in milk 18, 385, 399 

Prevention of typhoid in milk 163 

Prophylaxis of typhoid in milk 163 

Pure-food laws , District of Columbia 809 

Pure milk possible 17 

Purity of milk 501 

Quantity of milk consumed 235 

Rabies 519 

Randall's Island 243 

Recipes for ice cream 273 

Regulation of milk supply 741, 745 

Requirements for pure milk 17 

Rickets 727 

Roberts, Norman 315 

Rochester, milk supply of 452 

Rock fever 213 

Ropy milk 523 

Rosenau, M. J 19, 429, 457, 639, 683 

St. Petersburg, milk supply of 17 

Sanitary inspection 557 

Sanitary inspection of dairies 20 

Sanitary score card 564 

Sanitary water supply 573 



Page. 

Scarlet fever 136 

Epidemics 95 

Milk as a cause of 23, 32 

Mortality 247 

Schereschewsky, J. W 21, 689 

Schroeder, E . C 19, 22, 529 

Score: 

For cattle 804 

For dairies 805 

Score card of dairies 564 

Scurvy 727 

Shipment of milk 618 

Sick, milk as a diet for the 244 

Sickness, milk ! 18, 215 

Skimmed milk, bacteria in 737 

Skimming milk. 381 

Slimy milk 523 

Springs 584 

Stables, care of 571 

Standard: 

For ice cream 284 

Of purity 453 

Of pure milk 434, 621, 624 

Standards for the control of milk 377 

Statistics, morbidity and mortality 233 

Sterile milk, a rare natural condition 16 

Sterilization, definition of 727 

Stiles, Ch. Wardell 18,227 

Stiles, Geo. W 255 

Straus, Nathan 21, 241 

Streptococci in milk 19, 489 

Stringy milk 523 

Supply, milk, of the District of Columbia 745 

Taste of milk 524 

Temperature, destruction, of milk ferments. 18 

Temperature of market milk 19, 460, 477, 646 

Temperature required to Mil bacteria 681 

Test, tuberculin 18, 19, 509, 607 

Tests, tuberculin, at Washington 179 

Thickening of milk 383 

Top milk, bacteria in 737 

Toxins in milk 651 

Transporation of milk 618 

Trask, John W 7, 25 

Trembles 215 

Tubercle bacilli in milk 17, 165, 502, 529, 684 

Tuberculin test 18,19,509,607 

Tuberculin tests, Washington, D. C 179 

Tuberculosis and milk 245 

Tuberculosis: 

Bovine 19, 502 

Human v. cattle 19 

Mortality from 245 

Tuberculous cattle 527 

Typhoid bacillus carriers 154 

Typhoid disseminated by milk 23, 246 

Typhoid epidemics 51, 118, 158 

Typhoid fever: 

Epidemiology 157 

In the District of Columbia 15 

Typhoid mortality , 246 

Udder, healthy 16 

Undulating fever 201 

Utensils of milking 562 

Virginia, springs and wells of 589 

Warsaw, milk supply of 451 



830 



Page. 
Washington, D. C: 

Bovine tuberculosis in 506 

Cream in 258 

Ice cream in 255 

Market milk in 17, 165,396, 437 

Milk typhoid epidemic 158 

Water supply of dairies 589 

Water pollution 578 

Water supply of dairies 23,616 

Water for dairy farms 44,573 

Watering milk 382 



Page. 

Weaning 714 

Webster, E d. H 20, 559 

Wells 582 

Wet nursing 714 

Wiley, Harvey W 18,22,251,743 

Wilmington, milk supply of 452 

Woodward, Wm. Creighton 21 , 22 , 747 

Woman's milk 697 

Wiirzburg, milk supply of 449 

Wyman, Walter 15 

I Z oo-parasitic diseases from milk 18, 227 



LIST OF BULLETINS OF THE HYGIENIC LABORATORY. 

[Those marked (*) are exhausted and no longer available for distribution. Those marked (f) may be pur- 
chased from the Superintendent of Documents, Government Printing Office, Washington, D. C] 

The laboratory of the Public Health and Marine-Hospital Service located in Wash- 
ington, D. C, is known as the Hygienic Laboratory and carries on investigations 
of infectious and contageous diseases and matters pertaining to the public health in 
accordance with act of Congress approved March 3, 1901. 
*1: Preliminary Note on the Viability of the Bacillus Pestis. By M. J. Rosenau. 
May 25, 1900. 19 pages. Paper. Out of print. 
2. Formalin Disinfection of Baggage without Apparatus. By M. J. Rosenau. 1900. 
34 pages. Paper. 
*3. Sulphur Dioxide as a Germicidal Agent. By H. D. Geddings. 1900. 12 pages. 

Paper. Out of print. 
*4. Viability of the Bacillus Pestis. By M. J. Rosenau. 1901. 44 pages. Paper. 
Out of print. 
5. An Investigation of a Pathogenic Microbe (B. typhhi murium-Danyz) Applied to 
the Destruction of Rats. By M. J. Rosenau. 1901. 11 pages. Paper. 
*6. Disinfection Against Mosquitoes with Formaldehyde and Sulphur Dioxide. By 

M. J. Rosenau. September, 1901. 20 pages. Paper. Out of print. 
f7. Laboratory Technique — Ring Test for Indol, by S. B. Grubbs and Edward 
Francis. Collodium Sacs, by S. B. Grubbs and Edward Francis. Micro- 
photography with Simple Apparatus. By H. B. Parker. May, 1902. 10 
pages. Two plates. Paper. Superintendent of documents, 5 cents. 
*8. Laboratory Course in Pathology and Bacteriology. By M. J. Rosenau. Revised 

edition. March, 1904. 79 pages. Paper. Out of print. 
f9. Presence of Tetanus in Commercial Gelatin. By John F. Anderson. Septem- 
ber, 1902. 6 pages. Paper. Superintendent of documents, 5 cents. 
*10. Report upon the Prevalence and Geographic Distribution of Hookworm Disease 
(Uncinariasis or Anchylostomiasis) in the United States. Second edition. 
By Ch. Wardell Stiles. February, 1903. 122 pages. 86 illustrations. 
Paper. Out of print. 
*11. An Experimental Investigation of Trypanosoma lewisi. By Edward Francis. 

February, 1903. 34 pages. 4 plates. Paper. Out of print. 
*12. The Bacteriological Impurities of Vaccine Virus — An Experimental Study. By 

M. J. Rosenau. March, 1903. 50 pages. Paper. Out of print. 
*13. A Statistical Study of the Intestinal Parasites of 500 White Male Patients at the 
United States Government Hospital for the Insane. By Philip E. Garri- 
son, Brayton H. Ransom, and Earle C. Stevenson. A Parasitic Roundworm 
(Aganomermis culitis n. g. n. sp.) in American Mosquitoes (Culex sollicitans). 
By Ch. Wardell Stiles. The Type Species of the Cestode Genus Hymeno- 
lepis. By Ch. Wardell Stiles. May, 1903. 23 pages. Paper. Out of 
print. 
*14. Spotted Fever (Tick Fever) of the Rocky Mountains. By John F. Anderson. 
July, 1903. 50 pages. 2 maps. 3 charts. 3 plates. 3 photographs. 
Paper. Out of print. 
*15. Inefficiency of Ferrous Sulphate as an Antiseptic and Germicide. By Allan J. 
McLaughlin. July, 1903. 7 pages. Paper. Out of print. 



II 

*16. The Antiseptic and Germicidal Properties of Glycerin. By M. J. Rosenau. 

September, 1903. 30 pages. Paper. Out of print. 
*17. Illustrated Key to the Trematode Parasites of Man. By Ch. Wardell Stiles. 

August, 1904. 66 pages. 88 illustrations. Paper. Out of print. 
*18. An Account of the Tapeworms of the Genus Hymenolepis Parasitic in Man, 

including Reports of Several New Cases of the Dwarf Tapeworm (H. nana) 

in the United States. By Bray ton H. Ransom. September, 1904. 138 

pages. 130 illustrations. Paper. Out of print. 
*19. A Method for Inoculating Animals with Precise Amounts. By M. J. Rosenau, 

October, 1904. 7 pages. 2 illustrations. Paper. Out of print 
*20. A Zoological Investigation into the Cause, Transmission, and Source of Rocky 

Mountain "Spotted Fever." By Ch. Wardell Stiles. April, 1905. 121 

pages. Paper. Out of print. 
21. The Immunity Unit for Standardizing Diphtheria Antitoxin (based on Ehrlich's 

Normal Serum). Official standard under act approved July 1, 1902. By 

M. J. Rosenau. 92 pages. 26 illustrations. Paper. (Second edition.) 
*22. Chloride of Zinc as a Deodorant, Antiseptic, and Germicide. By T. B. McClintic. 

May, 1905. 24 pages. Out of print. 
*23. The Changes in the Pharmacopoeia of the United States of America. Eighth 

decennial revision (official from September 1, 1905). By Reid Hunt and 

Murray Gait Motter. August, 1905. 122 pages. Paper. Out of print. 
24. The International Code of Zoological Nomenclature, as applied to Medicine. 

By Ch. Wardell Stiles. September, 1905. 50 pages. Paper. 
*25. Illustrated Key to the Cestode Parasites of Man. By Ch. Wardell Stiles. June, 

1906. 104 pages. 166 illustrations. Paper. Out of print. 
*26. On the Stability of the Oxidases and their Conduct toward Various Reagents. 

The Conduct of Phenolphthalein in the Animal Organism. A Test for 

Saccharin and a Simple Method of Distinguishing between Cumarin and 

Vanillin. The Toxicity of Ozone and other Oxidizing Agents to Lipase. 

The Influence of Chemical Constitution on the Lipolytic Hydrolysis of 

Ethereal Salts. By J. H. Kastle. January, 1906. 51 pages Paper. 

Out of print. 
*27. The Limitations of Formaldehyde Gas as a Disinfectant, with Special Reference 

to Car Sanitation. By Thomas B. McClintic. April, 1906. 112 pages. 

Paper. Out of print. 
*28. A Statistical Study of the Prevalence of Intestinal Worms in Man. By Ch. 

Wardell Stiles and Philip E. Garrison. August, 1906. 77 pages. Paper. 

Out of print. 
*29. A Study of the Cause of Sudden Death Following the Injection of Horse Serum. 

By M. J. Rosenau and John F. Anderson. April, 1906. 95 pages. Paper. 

Out of print. 
f30. 1. Maternal Transmission of Immunity to Diphtheria Toxine. 

2. Maternal Transmission of Immunity to Diphtheria Toxine and Hypersus- 

ceptibility to Horse Serum in the Same Animal. By John F. Anderson. 

August, 1906. 19 pages. Paper. Superintendent of documents. 10 cents. 
f31. Variations in the Peroxidase Activity of the Blood in Health and Disease. By 

Joseph H. Kastle and Harold L. Amoss. August, 1906. 26 pages. Paper. 

Superintendent of documents. 10 cents. 
f32. A Stomach Lesion in Guinea Pigs caused by Diphtheria Toxine and its Bearing 

upon Experimental Gastric Ulcer. By M. J. Rosenau and John F. Ander- 
son. October, 1906. 10 pages. 11 illustrations. Paper. Superintendent 

of documents. 10 cents. 
*33. Studies in Experimental Alcoholism. By Reid Hunt. February, 1907. 43 

pages. Paper. Out of print. 



in 

f34. 1. Agamofilaria georgiana n. sp., an Apparently New Roundworm Parasite from 
the Ankle of a Negress. 

2. The Zoological Characters of the Roundworm Genus Filaria Mueller, 1787. 

3 . Three New American Cases of Infection of Man with Horse-hair Worms (species 

Paragordius varius), with summary of all cases reported to date. By Ch. 
Wardell Stiles. May, 1907. 75 pages. 55 illustrations. Paper. Super- 
intendent of documents. 10 cents. 

f35. Report on the Origin and Prevalence of Typhoid Fever in the District of Colum- 
bia. By M. J. Rosenau, L. L. Lumsden, and Joseph H. Kastle (including 
the following articles: Sanitary Inspection of Table Waters Vended in 
Washington, D. C, by Joseph Goldberger; Typhoid Bacillus Carriers, by 
Joseph Goldberger; The Longevity of B: Typhosus Outside the Human 
Body, by A. M. Stimson; The Alleged Role of Intestinal Worms as Inocu- 
lating Agents in Typhoid Fever, by Ch. Wardell Stiles; A Sanitary Survey 
of the Drainage Basin of the Potomac River, by Joseph Goldberger). Feb- 
ruary, 1907. 361 pages. 9 maps. 7 charts. 2 diagrams. 6 figures. Paper. 
Superintendent of documents. $1. 

f36. Studies upon Hypersusceptibility and Immunity. By M. J, Rosenau and John 
F. Anderson. April, 1907. 69 pages. Paper. Superintendent of docu- 
ments. 10 cents. 

f37. Index-Catalogue of Medical and Veterinary Zoology. Subjects: Trematoda and 
Trematode Diseases. By Ch. Wardell Stiles and Albert Hassell. June, 
1908. 398 pages. Paper. Superintendent of documents. 30 cents. 
38. The Influence of Antitoxin upon Post-Diphtheritic Paralysis. By M. J. Rosenau 
and John F. Anderson. June, 1907. 34 pages. Paper. 

f39. The Antiseptic and Germicidal Properties of Solutions of Fermaldehyde and 
their Action upon Toxines. By John F. Anderson. July, 1907. 48 pages. 
Paper. Superintendent of documents. 10 cents. 

f40. 1. The Occurrence of a Proliferating Cestode Larva (Sparganum proliferum) in 
Man in Florida. By Ch. Wardell Stiles. 

2. A Reexamination of the Type Specimen of Filaria restiformis Leidy, 1880 — 

Agamomermis restiformis. By Ch. Wardell Stiles. 

3. Observations on Two New Parastic Trematode Worms: Homalagaster philip- 

pinensis n. sp., Agamodistomum nanus n. sp. By Ch. Wardell Stiles and 
Joseph Goldberger. 

4. A Reexamination of the Original Specimen of Taenia saginata obietina (Wein- 

land, 1858). By Ch. Wardell Stiles and Joseph Goldberger. May, 1908. 
43 pages. 66 illustrations. Paper. Superintendent of documents. 20 
cents. 
f41. Milk and its Relation to the Public Health. By various authors. January, 1908. 
760 pages. 51 illustrations. Buckram. Superintendent of documents. 
90 cents. 

1. Introduction by Walter Wyman. 

2. Milk as a Cause of Epidemics of Typhoid Fever, Scarlet Fever, and Diph- 

theria. By John W. Trask. 

3. The Milk Supply of Cities in Relation to the Epidemiology of Typhoid Fever. 

By L. L. Lumsden. 

4. The Frequency of Tubercle Bacilli in the Market Milk of the City of Wash- 

ington, D. C. By John F. Anderson. 

5. The Relation of Goat's Milk to the Spread of Malta Fever. By John F. 

Anderson. 

6. Milk Sickness. By George W. McCoy. 

7. The Relation of Cow's Milk to Zooparasite Diseases of Man. By Ch. Wardell 

Stiles. 
45276°— Bull. 56—12 53 



IV 

8. Morbidity and Mortality Statistics as Influenced by Milk. By J. M. Eager. 

9. Ice Cream. By Harvey W. Wiley. 

10. The Chemistry of Milk. By Joseph H. Kastle. 

11. The Number of Bacteria in Milk and The Value of Bacterial Counts. By 

Milton J. Rosenau. 

12. The Germicidal Property of Milk. By Milton J. Rosenau and George W. 

McCoy. 

13. The Significance of Leucocytes and Streptococci in Milk. By William Whit- 

field Miller. 

14. Conditions and Diseases of the Cow Injuriously Affecting the Milk. By 

John R. Mohler. 

15. Sanitary Inspection and Its Bearings on Clean Milk. By Ed. H. Webster. 

16. Sanitary Water Supplies for Dairy Farms. By B. Meade Bolton. 

17. Methods and Results of the Examination of Water Supplies of Dairies Supply- 

ing the District of Columbia. By B. Meade Bolton. 

18. The Classification of Market Milk. By A. D. Melvin. 

19. Certified Milk and Infant Milk Depots. By John W. Kerr. 

20. Pasteurization. By Milton J. Rosenau. 

21. Infant Feeding. By Joseph W. Schereschewsky. 

22. The Municipal Regulation of the Milk Supply of the District of Columbia. 

By W. C. Woodward. 
f42. The Thermal Death Points of Pathogenic Micro-Organisms in Milk. By M. J. 
Rosenau. January, 1908. 85 pages. 1 illustration. Paper. Superin- 
tendent of documents. 15 cents. 

43. The Standardization of Tetanus Antitoxin (An American unit established under 

authority of the act of July 1, 1902). By M. J. Rosenau and John F. Ander- 
son. March, 1908. 59 pages. Paper. (Second edition.) 

44. Report No. 2 on the Origin and Prevalence of Typhoid Fever in the District of 

Columbia, 1907. By M. J. Rosenau, L. L. Lumsden, and Joseph H. Kastle. 

63 pages. 7 maps. 4 charts. Paper. 
f45. Further Studies upon Anaphylaxis. By M. J. Rosenau and John F. Anderson. 

61 pages. Paper. Superintendent of documents. 10 cents. 
f46. Hepatozoon perniciosum (n. g., n. sp.); a hsemogregarine pathogenic for white 

rats; with a description of the sexual cycle in the intermediate host, a mite 

(lelaps echidninus) . By W.W.Miller. 1908. 48 pages. 20 plates. Paper. 

Superintendent of documents. 25 cents. 
f47. Studies on Thyroid. I. The Relation of Iodine to the Physiological Activity of 

Thyroid Preparations. By Reid Hunt and Atherton Seidell. October, 

1908. 115 pages. Paper. Superintendent of documents. 15 cents. 
f48. The Physiological Standardization of Digitalis. By Charles Wallis Edmund 

and Worth Hale. December, 1908. 61 pages. Paper. Superintendent of 

documents. 10 cents. 

49. Digest of Comments on the Pharmacopoeia of the United States of America. 

By Murray Gait Motter and Martin I. Wilbert. March, 1909. 295 pages. 
Paper. 

50. Further Studies upon the Phenomenon of Anaphylaxis. By M. J. Rosenau and 

John F. Anderson. April, 1909. 52 pages. Paper. 

51. Chemical Tests for Blood. By J. H. Kastle. April, 1909. 59 pages. Bibliog- 

raphy. Paper. 

52. Report No. 3 on the Origin and Prevalence of Typhoid Fever in the District of 

Columbia. By M. J. Rosenau, L. L. Lumsden, and J. H. Kastle. October, 
19091 160 pages. 10 charts. 10 maps. Paper. 

53. The Influence of Certain Drugs upon the Toxicity of Acetanilide and Anti- 

pyrine. By Worth Hale. September, 1909. 60 pages. 8 illustrations. 
Paper. 



54. The Fixing Power of Alkaloids on Volatile Acids and its Application to the esti- 

mation of Alkaloids with the Aid of Phenolphthalein or by the Volhard 
Method. By Elias Elvove. July, 1909. 25 pages. Paper. 

55. Quantitative Pharmacological Studies: Adrenalin and Adrenalin-like Bodies. 

By W. H. Schultz. April, 1909. 77 pages. 24 tables. 4 illustrations. 
Bibliography. Paper. 

56. Milk and Its Relation to the Public Health. (Revised and enlarged edition of 

Bulletin No. 41.) By various authors. March, 1909. 828 pages. 67 charts 
and illustrations. Paper. (Second edition.) 

1. Introduction by Walter Wyman. 

2. Milk as a Cause of Epidemics of Typhoid Fever, Scarlet Fever, and Diph- 

theria. By John W. Trask. 

3. The Milk Supply of Cities in Relation to the Epidemiology of Typhoid Fever. 

By L. L. Lumsden. 

4. Frequency of Tubercle Bacilli in the Market Milk of Washington, D. C. By 

John F. Anderson. 

5. The Relation of Goat's Milk to the Spread of Malta Fever. By John F. 

Anderson. 

6. Milk Sickness. George W. McCoy. 

7. Relation of Cow's Milk to the Zooparasitic Diseases of Man. By Ch. Wardell 

Stiles. 

8. Morbidity* and Mortality Statistics as Influenced by Milk. By J. M. Eager. 

9. Ice Cream. -By Harvey W. Wiley. 

10. The Chemistry of Milk. By Joseph H. Kastle and Norman Roberts. 

11. The Number of Bacteria in Milk and the Value of Bacterial Counts. By 

M. J. Rosenau. 

12. The Germicidal Properties of Milk. By M. J. Rosenau and George W. McCoy. 

13. The Significance of Leucocytes and Streptococci in Milk. By W. W. Miller. 

14. Conditions and Diseases of the Cow Injuriously Affecting the Milk. By 

John R. Mohler. 

15. The Relation of the Tuberculosis Cow to Public Health. By E. C. Schroeder. 

16. Sanitary Inspection and its Bearing on Clean Milk. By Ed. H. Webster. 

17. Sanitary Water Supplies for Dairy Farms. By B. Meade Bolton. 

18. Methods and Results of the Examination of Water Supplies of Dairies Sup- 

plying the District of Columbia. By B. Meade Bolton. 

19. The Classification of Market Milk. By A. D. Melvin. 

20. Certified Milk and Infants' Milk Depots. By J. W. Kerr. 

21. Pasteurization. By M. J. Rosenau. 

22. The Thermal Death Points of Pathogenic Micro-Organisms in Milk. By M. J. 

Rosenau. 

23. Infant Feeding. By Joseph W. Schereschewsky. 

24. The Relative Proportion of Bacteria in Top Milk (Cream Layer) and Bottom 

Milk (Skim Milk), and its Bearing on Infant Feeding. By John F. Ander- 
son. 

25. National Inspection of Milk. By Harvey W. Wiley. 

26. The Municipal Regulation of the Milk Supply of the District of Columbia. 

By Wm. Creighton Woodward. 
f57. I. The presence of Tubercle Bacilli in the Circulating Blood in Clinical and 
Experimental Tuberculosis. By John F. Anderson. 
II. The Viability of the Tubercle Bacillus. By M. J. Rosenau. 

September, 1909. 42 pages. Bibliography. Paper. Superintendent of 
documents. 5 cents. 



VI 

58. Digest of Comments on the Pharmacopoeia of the United States (eighth decennial 

revision) and the National Formulary (third edition) for the Period ending 
December 31, 1906. By Murray Gait Motter and Martin I. Wilbert. De- 
cember, 1909. 523 pages. Paper. 

59. The Oxidases and Their Action in General Catalysts Concerned in Biological 

Oxidations. By Joseph H. Kastle. December, 1909. 164 pages. Paper. 

60. A Study of the Anatomy of Watsonius (n. g.) Watsoni of Man and of Nineteen 

Allied Species of the Mammalian Trematode Worms of the Superfamily 
Paramphistomoidea. By Ch. W. Stiles and Joseph Goldberger. April, 
1910. 264 pages. 205 illustrations. Paper. 

61. Quantitative Pharmacological Studies: Relative Physiological Activity of some 

Commercial Solutions of Epinephrin. By W. H. Schultz. January, 1910. 
30 pages. Bibliography. 15 tables. Paper. 

62. The Taxonomic Value of the Microscopic Structures of the Stigmal Plates in 

the Tick Genus Dermacentor. By Ch. Wardell Stiles. August, 1910. 72 
pages. 43 plates. 134 figures. Paper. 
f63. Digest of Comments on the Pharmacopoeia of the United States of America 
(Eighth Decennial Revision) and the National Formulary (Third Edition) 
for the Calendar Year ending December 31, 1907. By Murray Gait Motter 
and Martin I. Wilbert. June, 1910. 464 pages. Paper. Superintendent 
of documents. 35 cents. 

64. Studies upon Anaphylaxis with Special Reference to the Antibodies Concerned. 

By John F. Anderson and W. H. Frost. June, 1910. 56 pages. 36 tables. 
Bibliography. Paper. 

65. Facts and Problems of Rabies. By A. M. Stimson. June, 1910. 90 pages. 

5 plates. Bibliography. Paper. (Second edition.) 

66. I. The influence of Age and Temperature on the Potency of Diphtheria Anti- 

toxin. By John F. Anderson. 18 tables. 2 charts. 
II. An Organism (pseudomonas protea) Isolated from Water, Agglutinated by 
the Serum of Typhoid Fever Patients. By W. H. Frost. 14 tables. 
4 charts. References. 

III. Some Considerations on Colorimetry, and a New Colorimeter. By Norman 

Roberts. 5 figures. 

IV. A Gas Generator, in Four Forms, for Laboratory and Technical Use. By 

Norman Roberts. 10 figures. 
June, 1910. 108 pages. Paper. 
f67. The Solubilities of the Pharmacopoeial Organic Acids and their Salts. By 
Atherton Seidell. June, 1910. 98 pages. 45 tables. 7 figures. Paper. 
Superintendent of documents, 15 cents. 

68. The Bleaching of Flour and the Effect of Nitrites on Certain Medicinal Sub- 

stances. By Worth Hale. June, 1910. 44 pages. 32 tables. Paper. 

69. The Effects of a Restricted Diet and of Various Diets upon the Resistance of 

Animals to Certain Poisons. By Reid Hunt. June., 1910. 93 pages. 
Paper. 

70. A Study of Melting-Points Determinations with Special Reference to the Melting- 

Point Requirements of the U. S. Pharmacopoeia. By G. A. Menge. Octo- 
ber, 1910. 101 pages. 7 tables. 22 figures. Bibliography. Paper. 

71. I. Some Known and Three New Endoparasitic Trematodes from American 

Fresh-Water Fish. By Joseph Goldberger. 
II. On Some New Parasitic Trematode Worms of the Genus Telorchis. By 

Joseph Goldberger. 
III. A New Species of Aihesmia from a Monkey. By Joseph Goldberger and 
Charles G. Crane. 
January, 1911. 61 pages. 8 plates. 25 figures. Paper. 



VII 

f72. I. Report on an Outbreak of Typhoid Fever at Omaha, Nebr, (1909-10). By 
L. L. Lumsden. 6 tables. 4 maps. 5 charts. Appendix. 

II. The Water Supply of Williamson, W. Va., and its Relation to an Epidemic 

of Typhoid Fever. By W. H. Frost. 13 tables. 1 map. 3 charts. 
November, 1910. 90 pages. Paper. Superintendent of documents. 15 
cents. 
73. The Effect of a Number of Derivatives of Choline and Analogous Compounds 
on the Blood Pressure. By Reid Hunt and R. de M. Taveau. March, 1911. 
136 pages. Paper. 

f74. Digitalis Standardization and the Variability of Crude and of Medicinal Prepa- 
rations. By Worth Hale. January, 1911. 53 pages. 5 tracings. 7 tables. 
Paper. Superintendent of documents. 10 cents. 
75. Digest of Comments on the Pharmacopoeia of the United States of America 
(Eighth Decennial Revision) and the National Formulary (Third Edition) 
for the Calendar Year ending December 31, 1908. By Murray Gait Mot- 
ter and Martin I. Wilbert. April, 1911. 564 pages. Paper. 

f76. The Physiological Standradization of Ergot. By Charles Wallis Edmunds and 
Worth Hale. July, 1911. 58 pages. Paper. Superintendent of docu- 
ments. 10 cents. 
77. .Sewage Pollution of Interstate and International Waters with Special Refer- 
ence to the Spread of Typhoid Fever. I. Lake Erie and the Niagara River. 
By Allan J. McLaughlin. July, 1911. 169 papes. 55 charts. 16 maps. 
Paper. 
78. Report No. 4 on the Origin and Prevalence of Typhoid Fever in the District of 
Columbia (1909). By L. L. Lumsden and John F. Anderson. (Including 
articles contributed by Thomas B. McClintic and Wade H. Frost.) October, 
1911. 196 pages. 27 charts. 15 maps. Paper. 

f79. Digest of Comments on the Pharmacopoeia of the United States of America 
(Eighth Decennial Revision) and the National Formulary (Third Edition) 
for the Calendar Year ending December 31, 1909. By Murray Gait Motter 
and Martin I. Wilbert. January, 1912. 730 pages. Paper. Superin- 
tendent of documents. 50 cents. 

f80. Physiological Studies on Anaphylaxis. By W. H. Schultz. January, 1912. 
62 pages. Paper. Superintendent of documents. 15 cents. 

81. Tissue Proliferations in Plasma Medium. By John Sundwall. 64 pages. 

25 figures. Bibliography. Paper. 

82. I. Method of Standardizing Disinfectant, with and without organic matter. 

By John F. Anderson and Thomas B. McClintic. 
II. The Determination of the Phenol Coefficient of some Commercial Disin- 
fectants. By Thomas B. McClintic, February, 1912. 74 pages. 4 figures, 
53 tables. Paper. 

83. Sewage Pollution of Interstate and International Waters with Special Reference 

to the Spread of Typhoid Fever. 
II. Lake Superior and St. Marys River. 

III. Lake Michigan and the Straits of Mackinac. 

IV. Lake Huron, St. Clair River, Lake St. Clair, and the Detroit River. 

V. Lake Ontario and St. Lawrence River. By A. J. McLaughlin. March, 
1912. 296 pages. 91 charts. 39 maps. Paper. 

84. Digest of Comments on the Pharmacopoeia of the United States of America (Eighth 

Decennial Revision) and the National Formulary (Thirl Edition) for the 
Calendar Year ending December 31, 1910. By Murray Gait Motter and 
Martin I. Wilbert. 

85. Index Catalogue of Medical and Veterinary Zoology. Subject: Cestodes. By 

Ch. W. Stiles. 



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